| NPI | 1700996451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: PA 0S-003291-L) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: PA OS003291L) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2023-05-01 |