| NPI | 1679560387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: WY 6689A) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: UT 5672024-1205) |
| Enumeration Date | 2005-09-29 |
| Last Update Date | 2024-02-13 |