| NPI | 1992113864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: KY R3453) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: TN 57805) |
| Enumeration Date | 2014-07-23 |
| Last Update Date | 2018-07-12 |