| NPI | 1720158181 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 93818) | 
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NV DO2463) | 
| 207Q00000X Family Medicine (Licence: IN 02003148A) | |
| 207V00000X Obstetrics & Gynecology (Licence: SC 93818) | |
| Enumeration Date | 2006-11-09 | 
| Last Update Date | 2025-09-16 |