| NPI | 1740266311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: FL ME82333) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: NY 227893) |
| Enumeration Date | 2005-12-15 |
| Last Update Date | 2023-03-07 |