| NPI | 1275576944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: KY 30828) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 20770) |
| 207V00000X Obstetrics & Gynecology (Licence: WI 37645020) | |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2014-06-24 |