| NPI | 1619949005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: FL 60493) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: FL ME60493) |
| Enumeration Date | 2006-02-01 |
| Last Update Date | 2023-01-25 |