| NPI | 1750559589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: CA A114893) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MI 4301088473) |
| Enumeration Date | 2008-02-14 |
| Last Update Date | 2015-02-25 |