| NPI | 1720108525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA G063445) |
| Additional Taxonomies | 207KA0200X Allergy & Immunology, Allergy (Licence: CA G63445) |
| 261Q00000X Clinic/Center (Licence: CA G63445) | |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2023-03-07 |