| NPI | 1659571800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO R9D59) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MO R9D59) |
| Enumeration Date | 2007-07-24 |
| Last Update Date | 2016-05-18 |