| NPI | 1912903774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: NC 19994) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NC 19994) |
| Enumeration Date | 2005-06-24 |
| Last Update Date | 2015-03-17 |