| NPI | 1972868495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207VG0400X Obstetrics & Gynecology, Gynecology (Licence: FL ME157084) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MN 60316) |
| 207V00000X Obstetrics & Gynecology (Licence: MI 4301101039) | |
| Enumeration Date | 2012-07-10 |
| Last Update Date | 2024-04-23 |