| NPI | 1992116073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: KS 05-37994) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 05-08994) |
| Enumeration Date | 2014-05-12 |
| Last Update Date | 2020-02-26 |