| NPI | 1780679001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: NY 123911) |
| Additional Taxonomies | 207KA0200X Allergy & Immunology, Allergy (Licence: NY 123911) |
| 207KI0005X Allergy & Immunology, Clinical & Laboratory Immunology (Licence: NY 123911) | |
| Enumeration Date | 2005-09-13 |
| Last Update Date | 2013-01-04 |