| NPI | 1356324842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR DO18093) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: OR DO18093) |
| Enumeration Date | 2005-11-29 |
| Last Update Date | 2010-08-02 |