| NPI | 1043252158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 05-32073) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: OK 4340) |
| 207QS0010X Family Medicine Sports Medicine (Licence: OK 4340) | |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2018-05-29 |