| NPI | 1316956055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-18244) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: KS 04-18244) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: KS 04-18244) | |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2015-04-06 |