| NPI | 1790734564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: MI 4301076537) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: PA MD428811) |
| 207R00000X Internal Medicine (Licence: MI 4301076537) | |
| Enumeration Date | 2006-05-09 |
| Last Update Date | 2019-02-08 |