| NPI | 1942654934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: VA 0101268716) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NC 2002-02487) |
| Enumeration Date | 2016-04-16 |
| Last Update Date | 2022-10-27 |