| NPI | 1639303852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: FL UO4175) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital |
| Enumeration Date | 2009-05-04 |
| Last Update Date | 2016-11-08 |