| NPI | 1174752661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0201X Pediatrics, Pediatric Allergy/Immunology (Licence: OH 35.127911) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35.127911) |
| Enumeration Date | 2009-07-06 |
| Last Update Date | 2023-10-12 |