| NPI | 1902985575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: CA G31785) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: WI 18959) |
| Enumeration Date | 2006-11-03 |
| Last Update Date | 2025-01-09 |