| NPI | 1639434475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A 121193) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: CA A 121193) |
| Enumeration Date | 2012-07-09 |
| Last Update Date | 2013-11-25 |