| NPI | 1801235148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: MI 5101020332) |
| Additional Taxonomies | 282E00000X (Licence: MI 5101020332) |
| Enumeration Date | 2013-06-20 |
| Last Update Date | 2022-07-21 |