| NPI | 1063413565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: SC 40067) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL ME39732) |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2017-01-11 |