| NPI | 1013175603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: KY 47965) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: VT 0420012378) |
| Enumeration Date | 2008-05-30 |
| Last Update Date | 2020-04-22 |