| NPI | 1356408066 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 208D00000X General Practice (Licence: FL OS8453) | 
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: FL 0S8453) | 
| Enumeration Date | 2007-01-02 | 
| Last Update Date | 2020-01-28 |