| NPI | 1649699711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0201X Pediatrics, Pediatric Allergy/Immunology (Licence: FL ME172392) |
| Additional Taxonomies | 2080P0201X Pediatrics, Pediatric Allergy/Immunology (Licence: OR MD192138) |
| Enumeration Date | 2014-04-15 |
| Last Update Date | 2026-04-28 |