| NPI | 1639123995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: OH 35-08-2565) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: WV 21461) |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2021-01-21 |