| NPI | 1104915032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: MI 4301405922) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301405922) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2020-09-22 |