| NPI | 1730185802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0201X Pediatrics, Pediatric Allergy/Immunology (Licence: LA MD.019414) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA MD.019414) |
| 174400000X Specialist (Licence: LA 019414) | |
| Enumeration Date | 2005-06-23 |
| Last Update Date | 2025-10-08 |