| NPI | 1629430822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: KY 57315) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: KY TP889) |
| 207RA0201X Internal Medicine Allergy & Immunology (Licence: MO 2020015516) | |
| 2080P0201X Pediatrics Pediatric Allergy/Immunology (Licence: MO 2020015516) | |
| Enumeration Date | 2016-03-26 |
| Last Update Date | 2022-10-07 |