| NPI | 1275538233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NV 15867) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: KS 0426465) |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2016-07-20 |