| NPI | 1376611202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: ID 5671744) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: VA 0102201236) |
| 207V00000X Obstetrics & Gynecology (Licence: NC 200201048) | |
| 207V00000X Obstetrics & Gynecology (Licence: FL OS19504) | |
| 207VX0000X Obstetrics & Gynecology, Obstetrics (Licence: FL OS19504) | |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2025-02-24 |