| NPI | 1073605200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: MT 11594) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: MD D0062345) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2015-07-31 |