| NPI | 1104813583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: ND PT16256) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MN 40227) |
| Enumeration Date | 2005-09-30 |
| Last Update Date | 2020-02-18 |