| NPI | 1033285697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: TX G0803) |
| Additional Taxonomies | 261Q00000X Clinic/Center (Licence: TX G0803) |
| Enumeration Date | 2006-11-27 |
| Last Update Date | 2009-03-19 |