| NPI | 1902484660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: FL 175389) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: KS 1902484660) |
| Enumeration Date | 2021-04-01 |
| Last Update Date | 2025-07-23 |