| NPI | 1740366913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: WA MD00042579) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: OR MD24825) |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2017-05-03 |