| NPI | 1780690636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0201X Pediatrics, Pediatric Allergy/Immunology (Licence: CA A24150) |
| Additional Taxonomies | 207KA0200X Allergy & Immunology, Allergy (Licence: CA A24150) |
| 2080A0000X Pediatrics, Adolescent Medicine (Licence: CA A24150) | |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2023-07-20 |