| NPI | 1659333185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 208000000X Pediatrics (Licence: VA 0101053432) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA GFE60613) |
| 2080P0201X Pediatrics Pediatric Allergy/Immunology (Licence: MD D0057672) | |
| Enumeration Date | 2006-04-03 |
| Last Update Date | 2007-07-08 |