| NPI | 1063605293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: NC 2012-00056) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: WI 51918) |
| 207K00000X Allergy & Immunology (Licence: KY 41230) | |
| Enumeration Date | 2007-08-21 |
| Last Update Date | 2012-05-16 |