| NPI | 1417938119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: NY 195509) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: NJ 25MA06007900) |
| Enumeration Date | 2005-11-09 |
| Last Update Date | 2023-03-07 |