| NPI | 1477180974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: NY 337437) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: CO TL.0009915) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO TL.0009915) | |
| Enumeration Date | 2020-03-25 |
| Last Update Date | 2025-12-08 |