| NPI | 1730115221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: CA G60876) |
| Additional Taxonomies | 207RA0201X Internal Medicine Allergy & Immunology (Licence: CA G60876) |
| Enumeration Date | 2006-06-25 |
| Last Update Date | 2010-10-14 |