| NPI | 1154380145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207KA0200X Allergy & Immunology, Allergy (Licence: FL ME6071997) |
| Additional Taxonomies | 207KA0200X Allergy & Immunology, Allergy (Licence: PA MD044201-L) |
| 207KA0200X Allergy & Immunology, Allergy (Licence: NY 198486-L) | |
| Enumeration Date | 2006-03-20 |
| Last Update Date | 2019-11-13 |