| NPI | 1306089230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: MN 59455) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MN 59455) |
| 207K00000X Allergy & Immunology (Licence: WI 55878) | |
| 208000000X Pediatrics (Licence: WI 55878) | |
| Enumeration Date | 2009-04-07 |
| Last Update Date | 2018-10-02 |