| NPI | 1568471480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: PA MD060665L) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: WV 18887) |
| Enumeration Date | 2006-08-07 |
| Last Update Date | 2015-01-23 |