| NPI | 1861855272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: MO 2022049875) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: OK 37070) |
| Enumeration Date | 2016-04-01 |
| Last Update Date | 2023-01-26 |