| NPI | 1912181231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: PA MD449896) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D72239) |
| 207R00000X Internal Medicine (Licence: VA 0101250526) | |
| Enumeration Date | 2007-12-21 |
| Last Update Date | 2021-08-08 |