| NPI | 1770748378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: NY 162746-1) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: PA MD047417L) |
| Enumeration Date | 2008-07-23 |
| Last Update Date | 2018-12-28 |