| NPI | 1104406420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: TX W7495) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX W7495) |
| Enumeration Date | 2021-04-11 |
| Last Update Date | 2026-08-04 |