| NPI | 1710034129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207KA0200X Allergy & Immunology, Allergy (Licence: FL ME067980) |
| Additional Taxonomies | 2080P0201X Pediatrics, Pediatric Allergy/Immunology (Licence: FL ME067980) |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2012-01-15 |