| NPI | 1962819813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301106178) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MI 43011060178) |
| Enumeration Date | 2014-07-11 |
| Last Update Date | 2018-10-10 |