| NPI | 1104049535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: WA MD00044091) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: RI MD10062) |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2021-05-04 |