| NPI | 1912075441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: TX P6524) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: MN 51275) |
| 207R00000X Internal Medicine (Licence: MI 79648) | |
| 207RA0201X Internal Medicine, Allergy & Immunology (Licence: TX P6524) | |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2024-12-09 |