| NPI | 1023100526 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: NC 39646) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NC 39646) |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2025-09-11 |