| NPI | 1912975574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: WA md00017613) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: OR md10611) |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2009-05-07 |