| NPI | 1114940079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: KY 0000000) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NY 157098) |
| 207V00000X Obstetrics & Gynecology (Licence: NC 2007-01803) | |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2019-06-11 |