| NPI | 1720079841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO R8486) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: MO 25720) |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2010-05-18 |