| NPI | 1912932476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: TX P9742) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 34.010391) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2021-04-29 |