| NPI | 1568843191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: TN 60751) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.137143) |
| Enumeration Date | 2015-06-09 |
| Last Update Date | 2022-03-23 |