| NPI | 1780049759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: FL ME174436) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: AZ 62060) |
| Enumeration Date | 2015-12-17 |
| Last Update Date | 2026-01-20 |