| NPI | 1104142678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: UT 12706124-1205) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MN 60490) |
| 207V00000X Obstetrics & Gynecology (Licence: OH 35125228) | |
| Enumeration Date | 2010-04-08 |
| Last Update Date | 2022-08-25 |