| NPI | 1417123498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: MN 56305) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: AZ 67122) |
| 207KA0200X Allergy & Immunology Allergy (Licence: MN 56305) | |
| Enumeration Date | 2008-04-30 |
| Last Update Date | 2023-04-03 |