| NPI | 1003355579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: VA 0102205363) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0102205363) |
| Enumeration Date | 2017-02-16 |
| Last Update Date | 2025-09-09 |