| NPI | 1700833647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: TX L2028) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WI 40268) |
| Enumeration Date | 2006-05-27 |
| Last Update Date | 2016-12-09 |