| NPI | 1588953764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207VX0201X Obstetrics & Gynecology, Gynecologic Oncology (Licence: VA 0101265399) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NC 2013-01775) |
| Enumeration Date | 2011-03-28 |
| Last Update Date | 2022-07-08 |