| NPI | 1649251265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: NV 19347) |
| Additional Taxonomies | 207KA0200X Allergy & Immunology, Allergy (Licence: MI 4301054586) |
| Enumeration Date | 2005-11-10 |
| Last Update Date | 2025-11-17 |