| NPI | 1053313676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: UT 61169401205) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NV 6068) |
| Enumeration Date | 2005-08-12 |
| Last Update Date | 2019-10-07 |