| NPI | 1114985173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: OH 35.124490) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 0430814) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: KS 0430814) | |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2020-12-02 |