| NPI | 1619961919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: ME MD28663) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MT 77872) |
| 207V00000X Obstetrics & Gynecology (Licence: OH 35-07-7934-W) | |
| Enumeration Date | 2005-09-01 |
| Last Update Date | 2024-10-15 |