| NPI | 1972506509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207KA0200X Allergy & Immunology, Allergy (Licence: VA 0101056392) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101056392) |
| 2080P0201X Pediatrics, Pediatric Allergy/Immunology (Licence: VA 0101056392) | |
| Enumeration Date | 2005-05-27 |
| Last Update Date | 2018-04-10 |