| NPI | 1205327608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: MO 2022031704) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MI 4301115156) |
| Enumeration Date | 2018-05-22 |
| Last Update Date | 2024-10-09 |