| NPI | 1699923128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207VE0102X Obstetrics & Gynecology Reproductive Endocrinology (Licence: VA 0101246833) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: AL 32393) |
| Enumeration Date | 2008-09-09 |
| Last Update Date | 2024-04-15 |