| NPI | 1821097643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: GA 031804) |
| Additional Taxonomies | 207KA0200X Allergy & Immunology, Allergy (Licence: GA 031804) |
| 207RA0201X Internal Medicine, Allergy & Immunology (Licence: GA 03180) | |
| Enumeration Date | 2005-07-14 |
| Last Update Date | 2020-10-07 |