| NPI | 1841230240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME93347) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: FL ME93347) |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2022-03-23 |