| NPI | 1265925499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207KA0200X Allergy & Immunology, Allergy (Licence: FL ME150753) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IA R-11306) |
| Enumeration Date | 2018-06-12 |
| Last Update Date | 2023-05-24 |