| NPI | 1801235577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: CO 58146) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MO 2013017856) |
| Enumeration Date | 2013-06-17 |
| Last Update Date | 2020-03-17 |