| NPI | 1548267305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: OH 35045162T) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: WV 12254) |
| 207K00000X Allergy & Immunology (Licence: PA MD036753L) | |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2023-02-23 |