| NPI | 1649414913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-45012) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.093378) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: KS 04-45012) | |
| Enumeration Date | 2009-04-29 |
| Last Update Date | 2025-08-26 |