| NPI | 1518253491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ R2284) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 006930) |
| 207V00000X Obstetrics & Gynecology (Licence: AZ 006930) | |
| Enumeration Date | 2011-06-20 |
| Last Update Date | 2020-11-06 |