| NPI | 1790772069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: IA 39501) |
| Additional Taxonomies | 207KA0200X Allergy & Immunology Allergy (Licence: IA 29844) |
| Enumeration Date | 2005-10-03 |
| Last Update Date | 2020-11-10 |