| NPI | 1568867638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207KA0200X Allergy & Immunology, Allergy (Licence: AK 105361) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: AK 105361) |
| Enumeration Date | 2014-10-30 |
| Last Update Date | 2025-04-15 |