| NPI | 1417488131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: ID M-16211) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO 2017021058) |
| 207K00000X Allergy & Immunology (Licence: MO 2020009905) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-03-23 |
| Last Update Date | 2023-03-27 |