NPI | 1619967007 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A88670) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD428878) |
207VG0400X Obstetrics & Gynecology Gynecology (Licence: PA MD428878) | |
Enumeration Date | 2005-10-26 |
Last Update Date | 2019-11-21 |