| NPI | 1134117187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: WA MD60109942) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: LA 023967) |
| Enumeration Date | 2005-10-12 |
| Last Update Date | 2012-01-24 |