| NPI | 1831123876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207VG0400X Obstetrics & Gynecology, Gynecology (Licence: LA MD.015750) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: LA MD.015750) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2020-10-30 |