| NPI | 1285700088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: KS 05-34983) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 390200000X) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: CO DR.0050921) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: KS 0534983) | |
| Enumeration Date | 2006-11-27 |
| Last Update Date | 2021-12-16 |