| NPI | 1952370686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: FL ME88605) |
| Additional Taxonomies | 174400000X Specialist (Licence: NJ MA06817800) |
| Enumeration Date | 2006-03-15 |
| Last Update Date | 2021-03-31 |