| NPI | 1518123603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207VX0000X Obstetrics & Gynecology Obstetrics (Licence: PR 18485) |
| Additional Taxonomies | 207VG0400X Obstetrics & Gynecology Gynecology (Licence: PR 18485) |
| Enumeration Date | 2008-07-29 |
| Last Update Date | 2023-05-09 |