| NPI | 1235136920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101039409) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: VA 0101039409) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2012-07-27 |