| NPI | 1932193513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: NY 149503) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 149503) |
| Enumeration Date | 2005-09-09 |
| Last Update Date | 2025-04-14 |