| NPI | 1114925211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: MA 77466) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MA 77466) |
| 207VM0101X Obstetrics & Gynecology Maternal & Fetal Medicine (Licence: MA 77466) | |
| Enumeration Date | 2005-07-12 |
| Last Update Date | 2014-05-08 |