| NPI | 1194007112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: MD D0040846) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MD D0040846) |
| Enumeration Date | 2011-09-15 |
| Last Update Date | 2011-09-15 |