| NPI | 1083872196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: CA A105562) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A105562) |
| 207KA0200X Allergy & Immunology, Allergy (Licence: PA MT200406) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-05-26 |
| Last Update Date | 2022-02-11 |