| NPI | 1548780653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: SC 83745) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MO 2017018654) |
| Enumeration Date | 2017-06-21 |
| Last Update Date | 2025-07-09 |