| NPI | 1619133600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207KA0200X Allergy & Immunology Allergy (Licence: CA A125923) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IL 125-052818) |
| 208000000X Pediatrics (Licence: WI 54495) | |
| Enumeration Date | 2008-07-30 |
| Last Update Date | 2015-06-17 |