| NPI | 1669532842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: WA OP00002163) |
| Additional Taxonomies | 207KA0200X Allergy & Immunology, Allergy (Licence: WA OP00002163) |
| 207RA0201X Internal Medicine, Allergy & Immunology (Licence: AR E-2006) | |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2021-09-14 |