| NPI | 1831106889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM 89-243) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NM 89-243) |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2023-11-30 |