| NPI | 1861756835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207VX0201X Obstetrics & Gynecology, Gynecologic Oncology (Licence: MI 4301101368) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MI 4301101368) |
| Enumeration Date | 2012-06-25 |
| Last Update Date | 2022-05-17 |