| NPI | 1417440587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: PA MT214866) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MT214866) |
| Enumeration Date | 2018-06-12 |
| Last Update Date | 2020-06-26 |