| NPI | 1255573952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: GA 62720) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: PA oto11290) |
| Enumeration Date | 2009-03-27 |
| Last Update Date | 2019-12-10 |