| NPI | 1699208421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: KY 60954) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 60954) |
| 208000000X Pediatrics (Licence: KY 60954) | |
| Enumeration Date | 2017-04-08 |
| Last Update Date | 2026-01-07 |