| NPI | 1134123854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207KA0200X Allergy & Immunology, Allergy (Licence: NY 149999) |
| Additional Taxonomies | 2080P0201X Pediatrics, Pediatric Allergy/Immunology (Licence: NY 149999) |
| Enumeration Date | 2005-06-09 |
| Last Update Date | 2015-03-26 |