| NPI | 1003013756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2010-00375) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MI 5101017157) |
| Enumeration Date | 2007-06-27 |
| Last Update Date | 2021-01-21 |