| NPI | 1558672691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: TX Q2725) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ R72163) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116024001) | |
| Enumeration Date | 2010-06-23 |
| Last Update Date | 2026-03-27 |