| NPI | 1306896451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: CA 20A9409) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: OH 34.011431) |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2021-12-17 |