| NPI | 1477637312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: NY 150159) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 150519) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2013-01-07 |