| NPI | 1477971141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: KS 04-43510) |
| Additional Taxonomies | 2080P0216X Pediatrics, Pediatric Rheumatology (Licence: KS 04-43510) |
| 2080P0216X Pediatrics, Pediatric Rheumatology (Licence: MO 2024014447) | |
| Enumeration Date | 2014-03-31 |
| Last Update Date | 2025-07-09 |