| NPI | 1538151204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: NE 21408) |
| Additional Taxonomies | 207KI0005X Allergy & Immunology Clinical & Laboratory Immunology (Licence: NE 21408) |
| Enumeration Date | 2005-08-18 |
| Last Update Date | 2011-06-30 |