| NPI | 1083737662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: VA 0101053653) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: VA 0101053653) |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2021-04-07 |