| NPI | 1548258783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: VA 0101246979) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: MD D70246) |
| 207K00000X Allergy & Immunology (Licence: DC MD038548) | |
| Enumeration Date | 2005-10-12 |
| Last Update Date | 2018-08-24 |