| NPI | 1598703621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0401X Family Medicine Addiction Medicine (Licence: MI 4301048048) |
| Additional Taxonomies | 207VG0400X Obstetrics & Gynecology Gynecology (Licence: MI 4301048048) |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2012-11-07 |