| NPI | 1104830249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: LA 327575) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: FL ME70820) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2021-11-02 |