| NPI | 1760479935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207KA0200X Allergy & Immunology, Allergy (Licence: TX L2041) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: TX L2042) |
| Enumeration Date | 2005-10-04 |
| Last Update Date | 2020-04-01 |