| NPI | 1609259456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: FL ME141702) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME141702) |
| 208000000X Pediatrics (Licence: FL ME141702) | |
| 2080P0201X Pediatrics, Pediatric Allergy/Immunology (Licence: FL ME141702) | |
| Enumeration Date | 2015-06-29 |
| Last Update Date | 2021-06-29 |