| NPI | 1972990141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME136380) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01077666A) |
| 207VX0000X Obstetrics & Gynecology, Obstetrics (Licence: GA 82699) | |
| Enumeration Date | 2015-04-24 |
| Last Update Date | 2020-11-18 |