| NPI | 1902148307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D0031731) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: MD D0031731) |
| Enumeration Date | 2013-03-23 |
| Last Update Date | 2013-03-23 |