| NPI | 1619144334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: GA 61597) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: KY R0951) |
| Enumeration Date | 2008-05-12 |
| Last Update Date | 2023-12-22 |