| NPI | 1326444514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 176B00000X Midwife (Licence: FL MW 301) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: FL 15-205) |
| Enumeration Date | 2014-11-14 |
| Last Update Date | 2015-10-12 |