| NPI | 1154306850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: WV 14750) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: NC 2005-00679) |
| 207K00000X Allergy & Immunology (Licence: PA MD437096) | |
| Enumeration Date | 2005-12-14 |
| Last Update Date | 2015-01-23 |