| NPI | 1780112896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RA0201X Internal Medicine, Allergy & Immunology (Licence: NY 307633) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: FL ME176436) |
| Enumeration Date | 2017-06-02 |
| Last Update Date | 2026-02-05 |