| NPI | 1811961204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207KA0200X Allergy & Immunology Allergy (Licence: AZ 51566) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA A45530) |
| 174400000X Specialist (Licence: AZ 51566) | |
| 207KA0200X Allergy & Immunology Allergy (Licence: CA A45530) | |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2022-09-08 |