| NPI | 1689696577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: WA MD.60178929) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WI 47038) |
| 208000000X Pediatrics (Licence: NC 2008-01016) | |
| 208M00000X Hospitalist (Licence: IL 036.096987) | |
| Enumeration Date | 2006-07-23 |
| Last Update Date | 2011-01-28 |