| NPI | 1174881601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: MO 2021012099) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: PA OS017813) |
| Enumeration Date | 2012-05-03 |
| Last Update Date | 2022-05-16 |