| NPI | 1255395620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: MD D0088565) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: FL ME86090) |
| Enumeration Date | 2006-04-13 |
| Last Update Date | 2020-04-02 |