| NPI | 1205988540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: CO CDR.0000210) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: LA L023779) |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2021-12-13 |