| NPI | 1154764876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: TN 63563) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2017-01023) |
| 208000000X Pediatrics (Licence: NC 2017-01023) | |
| 2080P0201X Pediatrics Pediatric Allergy/Immunology (Licence: TN 63563) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 2080P0201X Pediatrics Pediatric Allergy/Immunology (Licence: NC 2017-01023) | |
| 2083P0901X Preventive Medicine Public Health & General Preventive Medicine (Licence: TN 63563) | |
| Enumeration Date | 2013-04-11 |
| Last Update Date | 2022-03-18 |