| NPI | 1295354264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: KS 94-11315) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: TX u0080) |
| Enumeration Date | 2020-04-10 |
| Last Update Date | 2023-08-14 |