| NPI | 1174562227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 0423650) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: KS 0423650) |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2013-07-25 |