| NPI | 1205851326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207KA0200X Allergy & Immunology, Allergy (Licence: MI 4301032767) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301032767) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2016-09-07 |