| NPI | 1154402253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00040899) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO DR.0054608) |
| 207VX0000X Obstetrics & Gynecology, Obstetrics (Licence: WA MD00040899) | |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2021-05-18 |