| 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 |