NPI | 1598736555 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME146327) |
Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: FL ACN1057) |
207V00000X Obstetrics & Gynecology (Licence: PR 6554) | |
Enumeration Date | 2006-01-30 |
Last Update Date | 2020-09-17 |