| NPI | 1770784126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: NC 2008-00077) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NC 117338) |
| 207V00000X Obstetrics & Gynecology (Licence: GU MTL2009-007) | |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2022-07-21 |