| NPI | 1487657615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: FL ME143023) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: NY 207668) |
| Enumeration Date | 2005-05-23 |
| Last Update Date | 2020-01-31 |