| NPI | 1902168107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: WA 60545508) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 252703) |
| 207R00000X Internal Medicine (Licence: WA MD 60545508) | |
| Enumeration Date | 2012-06-13 |
| Last Update Date | 2022-07-21 |