NPI | 1720438989 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD61043516) |
Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: WA MD61043516) |
Enumeration Date | 2016-06-20 |
Last Update Date | 2025-02-06 |