| NPI | 1659786440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RA0201X Internal Medicine, Allergy & Immunology (Licence: NY 292021) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: NY 292021) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-06-30 |
| Last Update Date | 2022-06-07 |