| NPI | 1740555952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207KA0200X Allergy & Immunology Allergy (Licence: SC 90586) |
| Additional Taxonomies | 207KA0200X Allergy & Immunology Allergy (Licence: TN 63741) |
| 207KA0200X Allergy & Immunology Allergy (Licence: MS 29167) | |
| Enumeration Date | 2012-03-21 |
| Last Update Date | 2025-08-12 |