| NPI | 1811421662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: ID O-1783) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: WI 21640-875) |
| Enumeration Date | 2017-04-19 |
| Last Update Date | 2023-02-02 |