| NPI | 1790722270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0201X Pediatrics, Pediatric Allergy/Immunology (Licence: MI 4301059885) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301059885) |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2017-01-13 |