| NPI | 1639148224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 13420) |
| Additional Taxonomies | 207KA0200X Allergy & Immunology, Allergy (Licence: GA 13420) |
| 207KA0200X Allergy & Immunology, Allergy (Licence: GA 013420) | |
| 207Q00000X Family Medicine (Licence: GA 013420) | |
| Enumeration Date | 2006-03-16 |
| Last Update Date | 2019-06-04 |