| NPI | 1619907672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207VG0400X Obstetrics & Gynecology, Gynecology (Licence: MO 2002002871) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NC 2008-00669) |
| 207VG0400X Obstetrics & Gynecology, Gynecology (Licence: KY TP157) | |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2022-06-20 |