| NPI | 1518025816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: KY 37990) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 29482) |
| 207VG0400X Obstetrics & Gynecology, Gynecology (Licence: TN 29482) | |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2022-11-04 |