| NPI | 1619255411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: CT 63977) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 63977) |
| Enumeration Date | 2011-07-27 |
| Last Update Date | 2019-09-11 |