| NPI | 1568460350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207KA0200X Allergy & Immunology Allergy (Licence: VA 0101032249) |
| Additional Taxonomies | 207KA0200X Allergy & Immunology Allergy (Licence: WV 14655) |
| Enumeration Date | 2005-07-14 |
| Last Update Date | 2013-12-02 |