| NPI | 1447645056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0201X Pediatrics, Pediatric Allergy/Immunology (Licence: MI 5101026582) |
| Additional Taxonomies | 2080P0201X Pediatrics, Pediatric Allergy/Immunology (Licence: OH 34.013297) |
| 2080P0201X Pediatrics, Pediatric Allergy/Immunology (Licence: KY 04746) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-03-31 |
| Last Update Date | 2022-08-10 |