| NPI | 1093719437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0201X Pediatrics, Pediatric Allergy/Immunology (Licence: CA G42041) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA G42041) |
| 207K00000X Allergy & Immunology (Licence: CA G42041) | |
| Enumeration Date | 2005-06-13 |
| Last Update Date | 2025-01-15 |