| NPI | 1982961843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: PA MD465799) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: CT 54431) |
| 207K00000X Allergy & Immunology (Licence: NJ 25MA10427500) | |
| Enumeration Date | 2012-04-17 |
| Last Update Date | 2020-01-17 |