| NPI | 1386616340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: FL 151265) |
| Additional Taxonomies | 208D00000X General Practice (Licence: WV 19661) |
| Enumeration Date | 2006-02-03 |
| Last Update Date | 2021-08-10 |