| NPI | 1700124427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207VM0101X Obstetrics & Gynecology, Maternal & Fetal Medicine (Licence: KY 46810) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: KY 46810) |
| Enumeration Date | 2013-01-30 |
| Last Update Date | 2017-08-22 |