| NPI | 1114965605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 30333) |
| Additional Taxonomies | 207VG0400X Obstetrics & Gynecology, Gynecology (Licence: AZ 30333) |
| Enumeration Date | 2006-06-04 |
| Last Update Date | 2020-02-25 |