| NPI | 1740745041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: VA 0101271195) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101271195) |
| Enumeration Date | 2019-01-31 |
| Last Update Date | 2025-06-18 |