| NPI | 1154409316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: OR 07945) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR 07945) |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2025-01-15 |