| NPI | 1003171539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: NC 2020-00921) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: WI 65497) |
| Enumeration Date | 2012-07-11 |
| Last Update Date | 2020-11-23 |