| NPI | 1174672463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207KA0200X Allergy & Immunology, Allergy (Licence: NJ 177662-1) |
| Additional Taxonomies | 207KA0200X Allergy & Immunology, Allergy (Licence: NJ MA60083) |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2007-07-08 |