| NPI | 1336104900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: DE C1-0024063) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NY 2080361) |
| 207Q00000X Family Medicine (Licence: NY 2080361) | |
| Enumeration Date | 2006-04-18 |
| Last Update Date | 2021-03-02 |