| NPI | 1730541319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0201X Pediatrics, Pediatric Allergy/Immunology (Licence: VA 0101274248) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 010127248) |
| 208000000X Pediatrics (Licence: WA 60928589) | |
| Enumeration Date | 2016-03-23 |
| Last Update Date | 2023-06-22 |