| NPI | 1053366187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NE 17711) |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: IA 38110) |
| 207V00000X Obstetrics & Gynecology (Licence: NE 17711) | |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2018-04-23 |