| NPI | 1174551113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX H0563) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: TX H0563) |
| 2080P0201X Pediatrics, Pediatric Allergy/Immunology (Licence: TX H0563) | |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2019-08-07 |