| NPI | 1770917940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: MO 2017000106) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MI 4301103384) |
| 207V00000X Obstetrics & Gynecology (Licence: IL 036146336) | |
| Enumeration Date | 2013-08-23 |
| Last Update Date | 2022-04-19 |