| NPI | 1790792869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0201X Pediatrics, Pediatric Allergy/Immunology (Licence: CA G23461) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA G23461) |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2018-07-05 |