| NPI | 1164756904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: AZ 48556) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: FL ME110800) |
| 208000000X Pediatrics (Licence: FL ME110800) | |
| 208000000X Pediatrics (Licence: AZ 48556) | |
| Enumeration Date | 2009-09-27 |
| Last Update Date | 2021-10-26 |