| NPI | 1407835085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: MO 103086) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MO DO103086) |
| Enumeration Date | 2006-01-12 |
| Last Update Date | 2025-02-12 |