| NPI | 1821145806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: NY 128966) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 128966) |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2007-07-08 |