| NPI | 1548226285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: WA MD60080408) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WI 1336-TEP) |
| 2080P0201X Pediatrics, Pediatric Allergy/Immunology (Licence: WA MD60080408) | |
| Enumeration Date | 2006-04-21 |
| Last Update Date | 2017-03-22 |