| NPI | 1538157383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 25663) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: IL 036113262) |
| 207K00000X Allergy & Immunology (Licence: OH 35043843W) | |
| Enumeration Date | 2005-10-06 |
| Last Update Date | 2010-08-24 |