| NPI | 1629061635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: KS 04-22451) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: MO R1J94) |
| Enumeration Date | 2005-08-24 |
| Last Update Date | 2007-07-08 |