| NPI | 1619173275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: CA A151684) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: HI mdr-5289) |
| Enumeration Date | 2007-06-21 |
| Last Update Date | 2017-11-17 |