| NPI | 1174557672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM 82-193) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO MD11376) |
| 207V00000X Obstetrics & Gynecology (Licence: MO MD11376) | |
| 207V00000X Obstetrics & Gynecology (Licence: NM 82-193) | |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2018-04-09 |