| NPI | 1649264425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RA0201X Internal Medicine, Allergy & Immunology (Licence: MD D0052600) |
| Additional Taxonomies | 207RA0201X Internal Medicine, Allergy & Immunology (Licence: DE C10004769) |
| Enumeration Date | 2005-09-07 |
| Last Update Date | 2011-10-28 |