| NPI | 1811952393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101226169) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: VA 0101226169) |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2015-01-30 |