| NPI | 1871552075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: MO R8H14) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: WI 376-320) |
| Enumeration Date | 2006-03-17 |
| Last Update Date | 2025-01-20 |