| NPI | 1114155496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: CA A124997) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MO 2009015668) |
| Enumeration Date | 2009-06-25 |
| Last Update Date | 2013-08-11 |