| NPI | 1154771715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: MO 2019043574) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: VA 0116029541) |
| Enumeration Date | 2016-06-14 |
| Last Update Date | 2021-02-05 |