| NPI | 1912994567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207KA0200X Allergy & Immunology Allergy (Licence: MA 214164) |
| Additional Taxonomies | 207KA0200X Allergy & Immunology Allergy (Licence: NH 11815) |
| Enumeration Date | 2005-09-29 |
| Last Update Date | 2013-11-20 |