| NPI | 1619970969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: TX F4444) |
| Additional Taxonomies | 207KA0200X Allergy & Immunology Allergy (Licence: TX F4444) |
| 2080P0201X Pediatrics Pediatric Allergy/Immunology (Licence: TX F4444) | |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2022-03-31 |