| NPI | 1629068036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: SC 19036) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: NC 9500596) |
| Enumeration Date | 2005-10-26 |
| Last Update Date | 2021-01-08 |