| NPI | 1003819624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: IA 32545) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: IL 036-100466) |
| 208000000X Pediatrics (Licence: IL 036-100466) | |
| 208000000X Pediatrics (Licence: IA 32545) | |
| Enumeration Date | 2005-05-27 |
| Last Update Date | 2018-03-17 |