| NPI | 1205892478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207KA0200X Allergy & Immunology, Allergy (Licence: IL 036-043906) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IL 036-043906) |
| 2080P0201X Pediatrics, Pediatric Allergy/Immunology (Licence: IL 036-043906) | |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2010-02-16 |