| NPI | 1700878691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: UT 12974480-1205) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: UT 12974480-1205) |
| Enumeration Date | 2005-08-17 |
| Last Update Date | 2023-03-01 |