| NPI | 1568431351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: NJ 25MA02833300) |
| Additional Taxonomies | 174400000X Specialist (Licence: NJ MA02833300) |
| Enumeration Date | 2006-03-15 |
| Last Update Date | 2021-11-15 |