| NPI | 1366470833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: ID M3919) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID M-3919) |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2019-05-06 |