| NPI | 1265826523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: MI 4301505653) |
| Additional Taxonomies | 207KA0200X Allergy & Immunology, Allergy (Licence: WA MD61042543) |
| Enumeration Date | 2015-03-25 |
| Last Update Date | 2021-09-28 |