| NPI | 1497954358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: CO 48591) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: OH 34.009046) |
| 208000000X Pediatrics (Licence: OH 34.009046) | |
| 208000000X Pediatrics (Licence: CO 48591) | |
| Enumeration Date | 2007-07-12 |
| Last Update Date | 2016-12-06 |