| NPI | 1619311016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207VM0101X Obstetrics & Gynecology, Maternal & Fetal Medicine (Licence: LA 324196) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: VT 042.0013742) |
| Enumeration Date | 2013-04-29 |
| Last Update Date | 2020-12-07 |