| NPI | 1225136104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NC 21455) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NC 21455) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2024-07-05 |