| NPI | 1457300915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: OH 35.084782) |
| Additional Taxonomies | 207KA0200X Allergy & Immunology Allergy (Licence: OH 35.084782) |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2015-06-01 |