| NPI | 1295779114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 14718) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: OK 24803) |
| 207Q00000X Family Medicine (Licence: AL MD.13299) | |
| 207V00000X Obstetrics & Gynecology (Licence: AL 13299) | |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2017-12-09 |