| NPI | 1154378495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207VG0400X Obstetrics & Gynecology, Gynecology (Licence: AL 15135) |
| Additional Taxonomies | 208D00000X General Practice (Licence: AL 15135) |
| Enumeration Date | 2006-05-30 |
| Last Update Date | 2020-11-11 |