| NPI | 1831129261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: GA 059015) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35.084875) |
| 207K00000X Allergy & Immunology (Licence: OH 35.084875) | |
| 208000000X Pediatrics (Licence: GA 059015) | |
| 2080P0201X Pediatrics, Pediatric Allergy/Immunology (Licence: OH 35.084875) | |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2016-03-29 |