| NPI | 1629084504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: TX L7855) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX L7855) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2008-05-31 |