| NPI | 1619968591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: PA MD440070) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD440070) |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2022-02-15 |