| NPI | 1780890178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: CO 0056905) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: ME 2229) |
| 208000000X Pediatrics (Licence: PA OT011240) | |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2021-06-23 |