NPI | 1225240682 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: KY 29482) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 29482) |
207QA0505X Family Medicine, Adult Medicine (Licence: NY 180194) | |
207V00000X Obstetrics & Gynecology (Licence: NY 180194) | |
Enumeration Date | 2007-05-05 |
Last Update Date | 2022-06-17 |