| NPI | 1083660641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301037072) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MI 37072) |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2022-06-08 |