| NPI | 1568697159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: CA A118815) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 6561710-1205) |
| 207Q00000X Family Medicine (Licence: HI 14286) | |
| 207Q00000X Family Medicine (Licence: CA A118815) | |
| Enumeration Date | 2009-05-26 |
| Last Update Date | 2019-01-05 |