| NPI | 1013900638 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: RI MD05146)  | 
| Additional Taxonomies | 207KA0200X Allergy & Immunology, Allergy (Licence: RI MD05146)  | 
| 208000000X Pediatrics (Licence: RI MD05146)  | |
| Enumeration Date | 2005-08-30 | 
| Last Update Date | 2025-08-06 |