| NPI | 1285703454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: KY 19060) |
| Additional Taxonomies | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: KY XF7678521) |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2021-09-09 |