| NPI | 1881667608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: MO 2002014395) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: KS 04-34430) |
| Enumeration Date | 2006-02-10 |
| Last Update Date | 2022-06-29 |