| NPI | 1447343546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-27726) |
| Additional Taxonomies | 207QA0505X Family Medicine Adult Medicine (Licence: KS 04-27726) |
| 207QS0010X Family Medicine Sports Medicine (Licence: KS 04-27726) | |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2013-11-15 |