| NPI | 1306020029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: CT 026745) |
| Additional Taxonomies | 207VG0400X Obstetrics & Gynecology, Gynecology (Licence: CT 026745) |
| 208D00000X General Practice (Licence: CT 026745) | |
| Enumeration Date | 2007-12-18 |
| Last Update Date | 2013-03-26 |