| NPI | 1013965128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: CO 27185) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: MA 223371) |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2020-04-02 |