| NPI | 1306855069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-20172) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: KS 04-20172) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2007-10-25 |