| NPI | 1003110008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: MN 56325) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: NY 257049-1) |
| Enumeration Date | 2011-01-05 |
| Last Update Date | 2014-02-26 |