| NPI | 1033125935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: CO 60580) |
| Additional Taxonomies | 174400000X Specialist (Licence: MO 2002023834) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2020-06-19 |