| NPI | 1699775437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: OH 35071039) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: OH 35070139R) |
| 207K00000X Allergy & Immunology (Licence: MI 4301069146) | |
| Enumeration Date | 2005-07-22 |
| Last Update Date | 2009-12-11 |