| NPI | 1629465257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0201X Pediatrics, Pediatric Allergy/Immunology (Licence: MO 2022011935) |
| Additional Taxonomies | 2080P0201X Pediatrics, Pediatric Allergy/Immunology (Licence: KS 04-45995) |
| Enumeration Date | 2015-04-21 |
| Last Update Date | 2025-12-07 |