| NPI | 1205254174 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: DC MD046205) | 
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MD D85528) | 
| 207V00000X Obstetrics & Gynecology (Licence: VA 0101269802) | |
| Enumeration Date | 2014-03-28 | 
| Last Update Date | 2020-08-10 |