| NPI | 1912083106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: MI 4301073354) |
| Additional Taxonomies | 2080P0201X Pediatrics Pediatric Allergy/Immunology (Licence: MI 4301073354) |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2018-04-17 |