| NPI | 1376819524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: OH 34.014935) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: SC 40614) |
| Enumeration Date | 2012-03-31 |
| Last Update Date | 2023-06-02 |