| NPI | 1972129773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: MO 2022048177) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MO 2020017220) |
| Enumeration Date | 2020-06-18 |
| Last Update Date | 2022-12-28 |