| NPI | 1770100497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: WI 86098-20) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2020019056) |
| Enumeration Date | 2020-06-29 |
| Last Update Date | 2025-09-02 |