| NPI | 1790312536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: CA A185856) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208000000X Pediatrics (Licence: CA 185856) | |
| Enumeration Date | 2020-03-23 |
| Last Update Date | 2025-07-09 |