| NPI | 1760640304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: TX P1793) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.013422) |
| Enumeration Date | 2008-05-30 |
| Last Update Date | 2022-06-09 |