| NPI | 1962404699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: TX N3582) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: OH 35-06-9141-C) |
| Enumeration Date | 2005-08-12 |
| Last Update Date | 2023-07-18 |