| NPI | 1437461050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: GA 25399) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 25399) |
| 207VG0400X Obstetrics & Gynecology, Gynecology (Licence: GA 25399) | |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: GA 25399) | |
| Enumeration Date | 2010-07-12 |
| Last Update Date | 2012-08-29 |