| 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 |