| NPI | 1124380936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2018-01874) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 284674) |
| 207V00000X Obstetrics & Gynecology (Licence: NC 2018-01874) | |
| 207V00000X Obstetrics & Gynecology (Licence: NY 284674) | |
| Enumeration Date | 2012-06-08 |
| Last Update Date | 2020-12-18 |