| NPI | 1639499783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: UT 5488876-1205) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MO 2010017742) |
| Enumeration Date | 2010-06-10 |
| Last Update Date | 2023-06-28 |