| NPI | 1376691626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: PA MD043325L) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: NJ 25MA06282100) |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2020-09-01 |