| NPI | 1912904038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: CA C10005662) |
| Additional Taxonomies | 207KA0200X Allergy & Immunology Allergy (Licence: CA C10005662) |
| 207RA0201X Internal Medicine Allergy & Immunology (Licence: CA C10005662) | |
| Enumeration Date | 2005-07-05 |
| Last Update Date | 2007-07-08 |