| NPI | 1003296625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: VA 0101279940) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: PA MD467606) |
| Enumeration Date | 2015-06-09 |
| Last Update Date | 2024-03-26 |