| NPI | 1750644589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: MN 61095) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MI 4301100885) |
| 207V00000X Obstetrics & Gynecology (Licence: NC 2020-04559) | |
| Enumeration Date | 2012-06-18 |
| Last Update Date | 2022-07-21 |