| NPI | 1790998458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: MD D0061993) |
| Additional Taxonomies | 174400000X Specialist (Licence: MD D0061993) |
| 174400000X Specialist (Licence: VA 0101223417) | |
| 207K00000X Allergy & Immunology (Licence: VA 0101342217) | |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2024-04-25 |