| NPI | 1891904850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: FL OS10170) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NC 2018-02345) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2023-01-26 |