| NPI | 1457810731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: OH 35.148338) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: KY 61256) |
| Enumeration Date | 2019-03-17 |
| Last Update Date | 2026-01-27 |