| NPI | 1821476979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: WA MD61305400) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 292974) |
| Enumeration Date | 2015-05-09 |
| Last Update Date | 2022-08-08 |