| NPI | 1326351131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: ND 14015) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO 2010018334) |
| 207R00000X Internal Medicine (Licence: ND 14015) | |
| Enumeration Date | 2010-07-21 |
| Last Update Date | 2016-12-28 |