| NPI | 1487716353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: TX G8095) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX g8095) |
| Enumeration Date | 2006-12-15 |
| Last Update Date | 2024-03-01 |