| NPI | 1679834097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 5101019989) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: MI 5101019989) |
| 174400000X Specialist (Licence: MI 5101019989) | |
| Enumeration Date | 2012-06-01 |
| Last Update Date | 2026-06-24 |