| NPI | 1154680049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: MN 109009) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NY 63273) |
| Enumeration Date | 2012-05-11 |
| Last Update Date | 2021-03-11 |