| NPI | 1588862312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: OR MD150278) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: WA MD60113845) |
| Enumeration Date | 2007-07-03 |
| Last Update Date | 2013-05-31 |