| NPI | 1003050204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: KS 04-37406) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: MO 2010026613) |
| Enumeration Date | 2009-05-01 |
| Last Update Date | 2022-09-30 |