| NPI | 1720083173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: MT 11976) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: VT 42-000-9879) |
| Enumeration Date | 2005-06-14 |
| Last Update Date | 2023-07-28 |