| NPI | 1649367541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0201X Pediatrics, Pediatric Allergy/Immunology (Licence: LA 201441) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: LA 201441) |
| 207K00000X Allergy & Immunology (Licence: TX L5832) | |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2021-02-05 |