| NPI | 1144473794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: FL ME86093) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: MN 16993) |
| Enumeration Date | 2008-10-28 |
| Last Update Date | 2008-10-28 |