| NPI | 1306048384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: KY 40868) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 40868) |
| 207Q00000X Family Medicine (Licence: WA MD00049231) | |
| Enumeration Date | 2007-06-03 |
| Last Update Date | 2021-05-10 |