| NPI | 1972617330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: OR MD13428) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: WA MD00027111) |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2022-02-04 |