| NPI | 1710973839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: WA MD 00040042) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: OR MD162938) |
| 207K00000X Allergy & Immunology (Licence: CA G88329) | |
| Enumeration Date | 2005-09-23 |
| Last Update Date | 2017-11-10 |