| NPI | 1093166787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: MN 69755) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MI 4301110714) |
| Enumeration Date | 2016-06-24 |
| Last Update Date | 2021-07-29 |