| NPI | 1174009534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: SD 13625) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NE 8353) |
| Enumeration Date | 2018-07-18 |
| Last Update Date | 2022-08-12 |