| NPI | 1619952009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: AZ 19408) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 19408) |
| 207RA0201X Internal Medicine, Allergy & Immunology (Licence: MN 32268) | |
| Enumeration Date | 2005-12-08 |
| Last Update Date | 2020-09-08 |