| NPI | 1124205539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: KY 49291) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MI 4301089512) |
| Enumeration Date | 2008-01-28 |
| Last Update Date | 2016-08-24 |