| NPI | 1174551055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: LA 014790) |
| Additional Taxonomies | 208D00000X General Practice (Licence: LA 014790) |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2022-07-28 |