| NPI | 1235369604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: ND 12846) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NE 6101) |
| Enumeration Date | 2009-07-20 |
| Last Update Date | 2019-12-03 |