| NPI | 1164956702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0201X Pediatrics, Pediatric Allergy/Immunology (Licence: CA A157393) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A157393) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-04-19 |
| Last Update Date | 2022-08-05 |