| NPI | 1649665886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: UT 10102300-1205) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: UT 10102300-1205) |
| Enumeration Date | 2015-04-04 |
| Last Update Date | 2021-11-09 |