| NPI | 1023249174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: AZ 50002) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: AZ 50002) |
| Enumeration Date | 2009-08-06 |
| Last Update Date | 2020-03-03 |