| NPI | 1750471066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207KA0200X Allergy & Immunology, Allergy (Licence: VA 0101243358) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 57.011975) |
| Enumeration Date | 2006-10-15 |
| Last Update Date | 2018-04-25 |