| NPI | 1609871227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207VX0000X Obstetrics & Gynecology, Obstetrics (Licence: CA A41038) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A41038) |
| Enumeration Date | 2005-06-20 |
| Last Update Date | 2021-06-30 |