| NPI | 1871763235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: FL ME101331) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: FL 101331) |
| Enumeration Date | 2008-03-01 |
| Last Update Date | 2024-01-17 |