| NPI | 1578096855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: MN 64201) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 64201) |
| 207RA0201X Internal Medicine, Allergy & Immunology (Licence: MO 2020011735) | |
| 207RA0201X Internal Medicine, Allergy & Immunology (Licence: MO 2021003853) | |
| Enumeration Date | 2017-04-04 |
| Last Update Date | 2022-06-29 |