| NPI | 1376075770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: MI 4301504436) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: SD 17050) |
| Enumeration Date | 2017-04-03 |
| Last Update Date | 2025-04-01 |