| NPI | 1760455869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207VX0000X Obstetrics & Gynecology, Obstetrics (Licence: MI 4301040053) |
| Additional Taxonomies | 174400000X Specialist (Licence: MI 4301040053) |
| Enumeration Date | 2006-02-09 |
| Last Update Date | 2022-11-02 |