| NPI | 1164464590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: AZ 52456) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: TX N5277) |
| Enumeration Date | 2006-06-11 |
| Last Update Date | 2019-11-20 |