| NPI | 1265041180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: PR 22568) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 22568) |
| Enumeration Date | 2020-07-27 |
| Last Update Date | 2026-04-07 |