| NPI | 1609994458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207KA0200X Allergy & Immunology, Allergy (Licence: FL ME107004) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301087873) |
| 207R00000X Internal Medicine (Licence: IL 36121438) | |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2010-09-27 |