| NPI | 1740474865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: PR 17371) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 17371) |
| Enumeration Date | 2007-08-31 |
| Last Update Date | 2021-07-15 |