| NPI | 1003857657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: IA 26470) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: WI 61454) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2019-05-28 |