NPI | 1235245853 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: KS 14905) |
Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: KS 0414905) |
Enumeration Date | 2006-08-23 |
Last Update Date | 2023-03-07 |