| NPI | 1619593423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD H0098446) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MD H0098446) |
| Enumeration Date | 2020-06-18 |
| Last Update Date | 2023-09-01 |