| NPI | 1790941334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207KA0200X Allergy & Immunology, Allergy (Licence: KY 04033) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA VAD 000) |
| 207R00000X Internal Medicine (Licence: KY 04033) | |
| Enumeration Date | 2008-08-04 |
| Last Update Date | 2023-11-07 |