| NPI | 1215010194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: HI 1991) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: CA 20A 7621) |
| 207V00000X Obstetrics & Gynecology (Licence: AZ 3839) | |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2019-09-24 |