| NPI | 1306849310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: NM MD2010-0726) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 47545) |
| 207Q00000X Family Medicine (Licence: IN 01053146A) | |
| 207V00000X Obstetrics & Gynecology (Licence: TX BP10025761) | |
| Enumeration Date | 2005-05-23 |
| Last Update Date | 2020-09-09 |