| NPI | 1760576516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: MI IM043839) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: MI 5304001863) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2018-11-13 |