NPI | 1245896869 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 05-47440) |
Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: KS 05-47440) |
Enumeration Date | 2019-05-20 |
Last Update Date | 2025-01-23 |