| NPI | 1699720714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM 93-435) |
| Additional Taxonomies | 207VG0400X Obstetrics & Gynecology, Gynecology (Licence: FL 0017585) |
| 207V00000X Obstetrics & Gynecology (Licence: NM 93-435) | |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2015-08-24 |