| NPI | 1770540023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AR C7474) |
| Additional Taxonomies | 207VX0000X Obstetrics & Gynecology, Obstetrics (Licence: AR c7474) |
| 208000000X Pediatrics (Licence: AR c7474) | |
| Enumeration Date | 2006-04-28 |
| Last Update Date | 2023-07-06 |