| NPI | 1730100751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0201X Pediatrics, Pediatric Allergy/Immunology (Licence: LA 08142R) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: LA 08142R) |
| Enumeration Date | 2006-07-23 |
| Last Update Date | 2013-04-03 |