| 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 |