| NPI | 1811973522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: NC 94-00660) |
| Additional Taxonomies | 207KA0200X Allergy & Immunology Allergy (Licence: NC 94-00660) |
| 207RA0201X Internal Medicine Allergy & Immunology (Licence: NC 94-00660) | |
| 2080P0201X Pediatrics Pediatric Allergy/Immunology (Licence: NC 94-00660) | |
| Enumeration Date | 2005-12-15 |
| Last Update Date | 2012-08-13 |