| NPI | 1124083712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: WI 42113-020) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: WV 20844) |
| 208000000X Pediatrics (Licence: WV 20884) | |
| Enumeration Date | 2006-04-18 |
| Last Update Date | 2017-01-12 |