| NPI | 1619051497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 19526) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO DR0057906) |
| 207VX0000X Obstetrics & Gynecology, Obstetrics (Licence: NE 19526) | |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2019-07-30 |