| NPI | 1740466549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: AZ 81048) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: AZ 42839) |
| Enumeration Date | 2008-01-11 |
| Last Update Date | 2010-07-27 |