| NPI | 1285681775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-31437) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: KS 0431437) |
| Enumeration Date | 2006-05-28 |
| Last Update Date | 2012-12-06 |