| NPI | 1639115652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: CA G69281) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: NY 5332910) |
| Enumeration Date | 2006-06-20 |
| Last Update Date | 2026-04-13 |