| NPI | 1205403920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AR E19538) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: AR E19538) |
| Enumeration Date | 2021-06-10 |
| Last Update Date | 2026-04-02 |