| NPI | 1114092962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: NC 980095) |
| Additional Taxonomies | 2080P0201X Pediatrics, Pediatric Allergy/Immunology (Licence: NC 980095) |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2010-01-28 |