| NPI | 1962852251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: FL OS16659) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: PA OT017172) |
| Enumeration Date | 2016-06-16 |
| Last Update Date | 2020-08-03 |