| NPI | 1972507366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: KS 0530651) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MO 2001015997) |
| Enumeration Date | 2005-06-13 |
| Last Update Date | 2018-02-27 |