| NPI | 1477991867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: CT 61789) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: NY 283311-1) |
| 208000000X Pediatrics (Licence: NY 283311-1) | |
| Enumeration Date | 2013-06-07 |
| Last Update Date | 2018-10-29 |