| NPI | 1770163925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA 20A25171) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: CO DR.0072889) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO DR.0072889) | |
| 2080P0201X Pediatrics, Pediatric Allergy/Immunology (Licence: CA 20A25171) | |
| Enumeration Date | 2021-04-12 |
| Last Update Date | 2026-06-10 |