| NPI | 1023012911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207KA0200X Allergy & Immunology Allergy (Licence: UT 8263858-1205) |
| Additional Taxonomies | 207KA0200X Allergy & Immunology Allergy (Licence: GA 037913) |
| Enumeration Date | 2005-06-08 |
| Last Update Date | 2015-06-03 |