| NPI | 1851563373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: SC MD 8050) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: SC MD 8050) |
| Enumeration Date | 2008-03-25 |
| Last Update Date | 2008-03-25 |