| NPI | 1912967464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: NJ MA40562) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: NY 1375261) |
| Enumeration Date | 2006-03-27 |
| Last Update Date | 2007-07-08 |