| NPI | 1730559600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: CA G075558) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: NY 158767) |
| Enumeration Date | 2015-10-04 |
| Last Update Date | 2015-10-04 |