| NPI | 1427189547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: VA 0101042359) |
| Additional Taxonomies | 261QM2500X Clinic/Center, Medical Specialty (Licence: VA 0101042359) |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2020-09-17 |