| NPI | 1598723512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: MA 77682) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: GU M-2043) |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2018-04-30 |