| NPI | 1881331312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: MN 79439) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX V1861) |
| Enumeration Date | 2022-05-16 |
| Last Update Date | 2025-05-14 |