| NPI | 1740952647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: OH 35.155197) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: MI 4351052085) |
| Enumeration Date | 2021-09-29 |
| Last Update Date | 2026-06-14 |