| NPI | 1700107208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: CO 54090) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 6875663) |
| Enumeration Date | 2010-06-18 |
| Last Update Date | 2015-03-24 |