| NPI | 1104176106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: PA MD469878) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: NJ 25MA11165900) |
| Enumeration Date | 2012-09-17 |
| Last Update Date | 2021-08-27 |