| NPI | 1487092292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: ID O-1017) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MO 2013017878) |
| Enumeration Date | 2013-06-13 |
| Last Update Date | 2022-07-21 |