| NPI | 1790039733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: CA 142800) |
| Additional Taxonomies | 207VG0400X Obstetrics & Gynecology Gynecology (Licence: MI 4301101741) |
| Enumeration Date | 2012-10-30 |
| Last Update Date | 2023-10-27 |