| NPI | 1508359035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: IL 036160076) |
| Additional Taxonomies | 207KA0200X Allergy & Immunology Allergy (Licence: DC MD210001682) |
| 207R00000X Internal Medicine (Licence: PA MT215920) | |
| Enumeration Date | 2018-06-09 |
| Last Update Date | 2024-08-29 |