| NPI | 1861923658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207SG0207X (Licence: MA 286339) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MA 286339) |
| Enumeration Date | 2017-03-23 |
| Last Update Date | 2024-08-29 |