| NPI | 1780979112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: CO 25434) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: AZ 6045) |
| 207R00000X Internal Medicine (Licence: AZ 6045) | |
| 207R00000X Internal Medicine (Licence: CO 25434) | |
| 208000000X Pediatrics (Licence: AZ 6045) | |
| 208000000X Pediatrics (Licence: CO 25434) | |
| Enumeration Date | 2011-06-14 |
| Last Update Date | 2015-12-03 |