| NPI | 1306615141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083S0010X Preventive Medicine, Sports Medicine (Licence: GA MT009726) |
| Additional Taxonomies | 2083S0010X Preventive Medicine, Sports Medicine (Licence: SC MAS.6263) |
| Enumeration Date | 2023-12-21 |
| Last Update Date | 2023-12-21 |