| NPI | 1912012402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: MD 07162) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD 07162) |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2007-07-08 |