| NPI | 1962434712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: FL OS16256) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MI 5101013139) |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2019-12-03 |