| NPI | 1114952322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: NC 95-00677) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: NC 9500677) |
| 207K00000X Allergy & Immunology (Licence: SC 20140) | |
| 207K00000X Allergy & Immunology (Licence: GA 042376) | |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2016-10-26 |