| NPI | 1710982293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: OR MD08914) |
| Additional Taxonomies | 174400000X Specialist (Licence: OR MD08914) |
| 207KA0200X Allergy & Immunology, Allergy (Licence: OR MD08914) | |
| Enumeration Date | 2005-06-20 |
| Last Update Date | 2015-07-28 |