| NPI | 1285710517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: CO 21722) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NE 32340) |
| Enumeration Date | 2006-10-30 |
| Last Update Date | 2022-11-03 |