| NPI | 1750387940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207KA0200X Allergy & Immunology, Allergy (Licence: CA A70338) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A70338) |
| Enumeration Date | 2005-06-22 |
| Last Update Date | 2022-02-11 |