| NPI | 1972697746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: NC 20584) |
| Additional Taxonomies | 207VG0400X Obstetrics & Gynecology Gynecology (Licence: NC 20584) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2023-03-07 |