| NPI | 1063525962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 325969) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: KY 02626) |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2025-05-23 |