| NPI | 1902807902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: PA MD014113E) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: NJ 25MA05175900) |
| Enumeration Date | 2005-08-02 |
| Last Update Date | 2015-07-13 |