| NPI | 1609878248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: CO DR.0052262) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: UT 8495885-1205) |
| Enumeration Date | 2005-08-12 |
| Last Update Date | 2020-09-23 |