| NPI | 1366532962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0201X Pediatrics, Pediatric Allergy/Immunology (Licence: UT 156955-1205) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: UT 746955-1205) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2020-08-31 |