| NPI | 1306947775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: NY 172663) |
| Additional Taxonomies | 207KA0200X Allergy & Immunology Allergy (Licence: NY 172663) |
| 2080P0201X Pediatrics Pediatric Allergy/Immunology (Licence: NY 172663) | |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2025-07-01 |