| NPI | 1104845775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0201X Pediatrics Pediatric Allergy/Immunology (Licence: CA G162574) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: FL ME46902) |
| 207K00000X Allergy & Immunology (Licence: KS 0438327) | |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2019-10-21 |