| NPI | 1730574328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: OH 35.133409) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: WI 75482-20) |
| 208000000X Pediatrics (Licence: OH 35.133409) | |
| Enumeration Date | 2015-04-01 |
| Last Update Date | 2024-05-31 |