| NPI | 1326487794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WY 10314A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID MRM-1347) |
| 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: WY 10314A) | |
| 207VX0000X Obstetrics & Gynecology, Obstetrics (Licence: WY 10314A) | |
| Enumeration Date | 2013-06-19 |
| Last Update Date | 2021-04-01 |