| NPI | 1821626896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: NC 2023-00666) |
| Additional Taxonomies | 207RP1001X Internal Medicine, Pulmonary Disease (Licence: NC 2023-00666) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 261020) | |
| Enumeration Date | 2020-03-27 |
| Last Update Date | 2025-08-12 |