| NPI | 1760833495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: FL me151868) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital |
| Enumeration Date | 2016-06-23 |
| Last Update Date | 2022-03-25 |