| NPI | 1578539029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: OK 12932) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care (Licence: OK 12932) |
| Enumeration Date | 2006-02-24 |
| Last Update Date | 2021-09-16 |