| NPI | 1023118809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4030063912) |
| Additional Taxonomies | 207VG0400X Obstetrics & Gynecology, Gynecology (Licence: MI 4030063912) |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2012-01-10 |