| NPI | 1053381012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: SC 14270) |
| Additional Taxonomies | 174400000X Specialist (Licence: SC 142704) |
| Enumeration Date | 2006-01-24 |
| Last Update Date | 2020-11-11 |