| NPI | 1811122369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207VG0400X Obstetrics & Gynecology, Gynecology (Licence: NC 2013-00899) |
| Additional Taxonomies | 207VG0400X Obstetrics & Gynecology, Gynecology (Licence: VA 0101275341) |
| 207VX0000X Obstetrics & Gynecology, Obstetrics (Licence: NC 2013-00899) | |
| Enumeration Date | 2009-05-27 |
| Last Update Date | 2023-02-07 |