| NPI | 1063686152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: NV 13197) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: AZ 81015) |
| Enumeration Date | 2008-04-18 |
| Last Update Date | 2021-12-15 |