| NPI | 1912352659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: DE C2-0013697) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS020283) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: DE C2-0013697) | |
| 207QS0010X Family Medicine, Sports Medicine (Licence: PA OS020283) | |
| Enumeration Date | 2016-05-02 |
| Last Update Date | 2020-06-04 |