| NPI | 1083631055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: CT 029466) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: RI MD09702) |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2022-01-10 |