| NPI | 1023031861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WY 5629a) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: WY 5629A) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2021-09-28 |