| NPI | 1912157009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: MA 274821) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: WA MD60055120) |
| 207K00000X Allergy & Immunology (Licence: NY 237436) | |
| 208000000X Pediatrics (Licence: NY 237436) | |
| Enumeration Date | 2008-09-24 |
| Last Update Date | 2020-05-11 |