| NPI | 1023164910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: VA 0102204034) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 58.001854) |
| 207KA0200X Allergy & Immunology, Allergy (Licence: MD H0075043) | |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2021-06-08 |