| NPI | 1497868145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: OR OR MD16160) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: WA WA MD00027120) |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2016-10-27 |