| NPI | 1659683902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207KA0200X Allergy & Immunology, Allergy (Licence: NY 264031) |
| Additional Taxonomies | 207KA0200X Allergy & Immunology, Allergy (Licence: NJ 25mb08722500) |
| Enumeration Date | 2010-07-01 |
| Last Update Date | 2012-08-03 |