| NPI | 1790994390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: WI 75044) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: IA 39501) |
| 207RA0201X Internal Medicine Allergy & Immunology (Licence: IA 39501) | |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2021-04-30 |