| NPI | 1770111858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: MN 69753) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 69753) |
| 207R00000X Internal Medicine (Licence: MN 30740) | |
| Enumeration Date | 2020-04-01 |
| Last Update Date | 2023-06-30 |