| NPI | 1245484351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: FL ME125929) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: NJ 25MA06986500) |
| Enumeration Date | 2008-11-17 |
| Last Update Date | 2021-11-01 |