| NPI | 1881044006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: KS 05-43441) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MI 5101022338) |
| Enumeration Date | 2016-06-18 |
| Last Update Date | 2020-08-01 |