| NPI | 1124090543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: WI 48108) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: WI 48108-020) |
| 207V00000X Obstetrics & Gynecology (Licence: AL 4306) | |
| 207V00000X Obstetrics & Gynecology (Licence: MN 47509) | |
| Enumeration Date | 2006-02-02 |
| Last Update Date | 2021-12-30 |