| NPI | 1487630364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: IL 036-084430) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: IL 036084430) |
| Enumeration Date | 2005-12-21 |
| Last Update Date | 2021-12-14 |