| NPI | 1073699724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: CA g31312) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: NY 192217) |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2007-07-08 |