| NPI | 1811149610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: NV 13863) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: TX N4469) |
| 207KA0200X Allergy & Immunology Allergy (Licence: TX N4469) | |
| 207KA0200X Allergy & Immunology Allergy (Licence: CA GS50788) | |
| 207KA0200X Allergy & Immunology Allergy (Licence: AZ 46354) | |
| Enumeration Date | 2008-10-13 |
| Last Update Date | 2020-09-02 |