| NPI | 1952364754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: FL ME0062088) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL Me0062088) |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2011-12-15 |