| NPI | 1902284029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0201X Pediatrics, Pediatric Allergy/Immunology (Licence: MA 276776) |
| Additional Taxonomies | 207RA0201X Internal Medicine, Allergy & Immunology (Licence: MA 276776) |
| 208000000X Pediatrics (Licence: MA 276776) | |
| Enumeration Date | 2015-05-08 |
| Last Update Date | 2020-03-06 |