| NPI | 1841220621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: CA A109088) |
| Additional Taxonomies | 207KA0200X Allergy & Immunology, Allergy (Licence: NY 227126) |
| 208000000X Pediatrics (Licence: NY 227126) | |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2015-06-22 |