| NPI | 1023122322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: TX Q1196) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL ME67710) |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2014-08-22 |