| NPI | 1053622761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: MN 54277) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: WI 60335) |
| Enumeration Date | 2010-06-28 |
| Last Update Date | 2024-05-25 |