| NPI | 1770795486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: NC 2015-01834) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: VA 0101245489) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116016518) | |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2021-02-24 |