| NPI | 1164523072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MT 104093) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MT 104093) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2023-04-18 |