| NPI | 1306813662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX F9792) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: TX F9792) |
| Enumeration Date | 2006-03-07 |
| Last Update Date | 2024-07-19 |