| NPI | 1104896562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207VX0201X Obstetrics & Gynecology, Gynecologic Oncology (Licence: MI 4301046383) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MI 4301046383) |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2017-05-03 |