| NPI | 1386699098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: WY 8674A) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MI 4301057359) |
| 207V00000X Obstetrics & Gynecology (Licence: CO 49335) | |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2023-11-27 |