| NPI | 1932424660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: LA 303260) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: NC 2015-00868) |
| Enumeration Date | 2010-04-06 |
| Last Update Date | 2023-03-22 |