| NPI | 1225147234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: KY 36376) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: HI 10224) |
| 207V00000X Obstetrics & Gynecology (Licence: NM 2001-49) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2022-01-07 |