| NPI | 1730201674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: FL ME110222) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 243002) |
| 207K00000X Allergy & Immunology (Licence: GA 066845) | |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2021-03-12 |