| NPI | 1770688434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME39710) |
| Additional Taxonomies | 207QA0401X Family Medicine Addiction Medicine (Licence: FL ME39710) |
| 207V00000X Obstetrics & Gynecology (Licence: FL ME39710) | |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2022-11-01 |