| NPI | 1467511816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: FL 75761) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: GA 45758) |
| Enumeration Date | 2006-12-08 |
| Last Update Date | 2013-02-12 |