| NPI | 1619177102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: NC 2010-00510) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: VA 0101243263) |
| Enumeration Date | 2007-07-23 |
| Last Update Date | 2013-09-04 |