| NPI | 1902811763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: VA 0101020576) |
| Additional Taxonomies | 174400000X Specialist (Licence: VA 0101020576) |
| Enumeration Date | 2006-07-30 |
| Last Update Date | 2020-03-29 |