| NPI | 1629022835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: NJ 25MA04259800) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: NY 153051) |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2017-03-31 |