| NPI | 1790722320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: CA A54916) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: MA 209515) |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2022-03-24 |