| NPI | 1114923307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 207KA0200X Allergy & Immunology Allergy (Licence: CA A35393) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A35393) |
| Enumeration Date | 2005-06-22 |
| Last Update Date | 2016-04-25 |