| NPI | 1104856665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: MS 23494) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: LA MD200786) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2015-01-05 |