| NPI | 1619061389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: WA MD00019575) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA MD00019575) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2025-12-30 |