| NPI | 1417983438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207KA0200X Allergy & Immunology, Allergy (Licence: CO 46383) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CO 46383) |
| 207RA0201X Internal Medicine, Allergy & Immunology (Licence: PA MD044657E) | |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2015-12-30 |