| NPI | 1285138768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207KA0200X Allergy & Immunology, Allergy (Licence: FL ME161212) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: FL ME0161212) |
| Enumeration Date | 2018-03-20 |
| Last Update Date | 2025-08-04 |