| NPI | 1508270372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: PA MD486497) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: PA FA4656178) |
| Enumeration Date | 2014-06-19 |
| Last Update Date | 2025-03-31 |