| NPI | 1659794279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: TX T9101) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101259052) |
| Enumeration Date | 2014-02-03 |
| Last Update Date | 2023-06-20 |