| NPI | 1790720795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: WI 66691) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: AR C-8356) |
| Enumeration Date | 2006-06-17 |
| Last Update Date | 2023-05-23 |