| NPI | 1760608442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: TX Q1385) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| 207R00000X Internal Medicine (Licence: VA 0101242884) | |
| 207K00000X Allergy & Immunology (Licence: VA 0101242884) | |
| 207R00000X Internal Medicine (Licence: TX Q1385) | |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2015-12-30 |