| NPI | 1104828151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207VG0400X Obstetrics & Gynecology, Gynecology (Licence: WI 43863) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: WI 43863) |
| Enumeration Date | 2005-06-02 |
| Last Update Date | 2021-07-12 |