NPI | 1760478408 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: CA C52058) |
Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: OH 35038681) |
207V00000X Obstetrics & Gynecology (Licence: PA MD035427L) | |
Enumeration Date | 2005-09-27 |
Last Update Date | 2022-05-08 |