| NPI | 1740284322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0300X Preventive Medicine Addiction Medicine (Licence: WI 24416) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: IA 21919) |
| 207V00000X Obstetrics & Gynecology (Licence: WI 24416) | |
| Enumeration Date | 2005-06-10 |
| Last Update Date | 2021-07-07 |