| NPI | 1629017819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: TN MD012917) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: GA 031373) |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2025-03-24 |