| NPI | 1023718756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: TX U1561) |
| Additional Taxonomies | 2080P0201X Pediatrics, Pediatric Allergy/Immunology (Licence: TX U1561) |
| 2080P0201X Pediatrics, Pediatric Allergy/Immunology (Licence: OH 35.076509) | |
| Enumeration Date | 2023-03-10 |
| Last Update Date | 2023-03-10 |