| NPI | 1245768738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: OH 35.147046) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: MI 4301502151) |
| 208000000X Pediatrics (Licence: MI 4301502151) | |
| Enumeration Date | 2017-05-26 |
| Last Update Date | 2023-11-09 |