| NPI | 1407966500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: CA A70227) |
| Additional Taxonomies | 207RA0201X Internal Medicine, Allergy & Immunology (Licence: CA A70227) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2012-01-11 |