| NPI | 1568468395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0401X Family Medicine Addiction Medicine (Licence: TX G8483) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: TX G8483) |
| Enumeration Date | 2005-06-27 |
| Last Update Date | 2019-09-17 |