| NPI | 1174985196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: GA 85621) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: KY R4176) |
| Enumeration Date | 2016-03-28 |
| Last Update Date | 2020-06-16 |