| NPI | 1790002517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: CA 19105) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: KY 03692) |
| Enumeration Date | 2010-05-04 |
| Last Update Date | 2021-11-12 |