| NPI | 1649251646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: UT 1758051205) |
| Additional Taxonomies | 174400000X Specialist (Licence: UT 1758051205) |
| Enumeration Date | 2005-11-08 |
| Last Update Date | 2019-04-18 |