| NPI | 1659891281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: KS 0546229) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NE 8027) |
| 208000000X Pediatrics (Licence: KS 0546229) | |
| 208D00000X General Practice (Licence: KS 0546229) | |
| Enumeration Date | 2017-06-24 |
| Last Update Date | 2022-12-05 |