| NPI | 1891787933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: WA MD0047434) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: WA MD00047434) |
| 207V00000X Obstetrics & Gynecology (Licence: TX J3498) | |
| Enumeration Date | 2005-08-16 |
| Last Update Date | 2021-08-04 |