NPI | 1174608111 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: KS 04-32151) |
Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: MO 2012028256) |
Enumeration Date | 2006-10-26 |
Last Update Date | 2022-01-04 |