| NPI | 1285022111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO LPC-0018287) |
| Additional Taxonomies | 207VX0000X Obstetrics & Gynecology, Obstetrics (Licence: AZ 40551) |
| 207V00000X Obstetrics & Gynecology (Licence: AZ 40551) | |
| 207VF0040X Obstetrics & Gynecology, Urogynecology and Reconstructive Pelvic Surgery (Licence: AZ 40551) | |
| 207VG0400X Obstetrics & Gynecology, Gynecology (Licence: AZ 40551) | |
| Enumeration Date | 2014-12-30 |
| Last Update Date | 2024-10-03 |