| NPI | 1356800619 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 208000000X Pediatrics (Licence: WV 3370) | 
| Additional Taxonomies | 2080P0201X Pediatrics, Pediatric Allergy/Immunology (Licence: WV 3370) | 
| Enumeration Date | 2019-03-17 | 
| Last Update Date | 2025-05-19 |