| NPI | 1194712810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AK MEDS6184) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: AK 6184) |
| Enumeration Date | 2005-09-29 |
| Last Update Date | 2023-08-15 |