| NPI | 1558660480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: WV 3250) |
| Additional Taxonomies | 2080P0201X Pediatrics, Pediatric Allergy/Immunology (Licence: WV 3250) |
| Enumeration Date | 2011-03-17 |
| Last Update Date | 2025-10-30 |