| NPI | 1942728167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083S0010X Preventive Medicine, Sports Medicine (Licence: CO AT.0001864) |
| Additional Taxonomies | 2083S0010X Preventive Medicine, Sports Medicine (Licence: KS 24-01217) |
| Enumeration Date | 2017-09-08 |
| Last Update Date | 2022-09-18 |