| NPI | 1306281571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: AZ 54563) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: AZ R73806) |
| Enumeration Date | 2013-05-01 |
| Last Update Date | 2023-06-26 |