| NPI | 1649332412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: WY 5881A) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: CO 38777) |
| Enumeration Date | 2006-12-15 |
| Last Update Date | 2010-12-08 |