| NPI | 1720088602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: GA 024823) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: GA 24823) |
| Enumeration Date | 2005-07-21 |
| Last Update Date | 2012-03-14 |