| NPI | 1972560456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: MD H0032415) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: VA 0102036831) |
| 207KA0200X Allergy & Immunology, Allergy (Licence: MD H0032415) | |
| 207KA0200X Allergy & Immunology, Allergy (Licence: VA 0102036831) | |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2014-04-23 |