| NPI | 1972565695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: AZ 17215) |
| Additional Taxonomies | 174400000X Specialist (Licence: AZ 17215) |
| Enumeration Date | 2006-04-06 |
| Last Update Date | 2021-01-27 |