| NPI | 1659363356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 022759) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: CT 022759) |
| Enumeration Date | 2005-08-18 |
| Last Update Date | 2018-03-26 |