| NPI | 1891161279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK NA) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 1879) |
| 207V00000X Obstetrics & Gynecology (Licence: NE 7596) | |
| Enumeration Date | 2015-08-19 |
| Last Update Date | 2018-05-23 |