| NPI | 1891833448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: TX G9409) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX G9409) |
| Enumeration Date | 2007-02-02 |
| Last Update Date | 2024-10-01 |