| NPI | 1609941582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: UT 5665828-1205) |
| Additional Taxonomies | 207VX0000X Obstetrics & Gynecology, Obstetrics (Licence: AZ 42731) |
| Enumeration Date | 2006-11-23 |
| Last Update Date | 2021-06-02 |