| NPI | 1861713034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: RI MD14698) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: CO CDRH.0058420) |
| Enumeration Date | 2010-06-22 |
| Last Update Date | 2020-04-16 |