| NPI | 1619922622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207KA0200X Allergy & Immunology, Allergy (Licence: NM MD2016-0029) |
| Additional Taxonomies | 207KA0200X Allergy & Immunology, Allergy (Licence: NJ 25MA075145) |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2017-06-02 |