| NPI | 1053920819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: AL L.5489R) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AL L.5489R) |
| 207R00000X Internal Medicine (Licence: MA 284625) | |
| 2080P0201X Pediatrics, Pediatric Allergy/Immunology (Licence: VA 0101283737) | |
| Enumeration Date | 2020-07-28 |
| Last Update Date | 2025-08-25 |