| NPI | 1700867074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MS 20416) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: GA 56408) |
| 208000000X Pediatrics (Licence: GA 56408) | |
| Enumeration Date | 2005-11-14 |
| Last Update Date | 2010-03-02 |