| NPI | 1598148223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207VX0201X Obstetrics & Gynecology, Gynecologic Oncology (Licence: AZ 33789) |
| Additional Taxonomies | 207VX0201X Obstetrics & Gynecology, Gynecologic Oncology (Licence: MT 8470) |
| 208D00000X General Practice (Licence: AZ 33789) | |
| Enumeration Date | 2015-06-30 |
| Last Update Date | 2015-10-13 |