| NPI | 1114976859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL 00012740) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: AL 00012740) |
| 208000000X Pediatrics (Licence: AL 00012740) | |
| Enumeration Date | 2006-05-09 |
| Last Update Date | 2010-01-27 |