| NPI | 1073512638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 207VG0400X Obstetrics & Gynecology Gynecology (Licence: NV 3597) |
| Additional Taxonomies | 207ZF0201X Pathology Forensic Pathology (Licence: NY 108816) |
| 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: NV 3597) | |
| Enumeration Date | 2005-07-17 |
| Last Update Date | 2007-07-08 |