| NPI | 1154684066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: TN 51627) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MI 4301096232) |
| Enumeration Date | 2012-06-18 |
| Last Update Date | 2022-03-14 |