| NPI | 1588988505 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: NJ 25MA09442000) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 255944) |
| Enumeration Date | 2010-03-19 |
| Last Update Date | 2025-02-11 |