| NPI | 1962896746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207KA0200X Allergy & Immunology, Allergy (Licence: AK 115363) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AK 115363) |
| Enumeration Date | 2015-03-19 |
| Last Update Date | 2025-04-15 |