| NPI | 1629280664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: WV 22761) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: NY P48044) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2014-01-03 |