| NPI | 1528303336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207VX0201X Obstetrics & Gynecology Gynecologic Oncology (Licence: NC 192545) |
| Additional Taxonomies | 207VX0201X Obstetrics & Gynecology Gynecologic Oncology (Licence: VA 0101275577) |
| Enumeration Date | 2012-12-05 |
| Last Update Date | 2024-01-09 |