| NPI | 1568624773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: MI 4301097382) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301097382) |
| 208000000X Pediatrics (Licence: MI 4301097382) | |
| Enumeration Date | 2008-06-29 |
| Last Update Date | 2016-03-07 |