| NPI | 1861985103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 94-09578) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: KS 04-43925) |
| Enumeration Date | 2018-06-12 |
| Last Update Date | 2025-12-10 |