| NPI | 1922077718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080P0201X Pediatrics, Pediatric Allergy/Immunology (Licence: NY 186600) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 186600) |
| Enumeration Date | 2006-03-15 |
| Last Update Date | 2026-05-11 |