| NPI | 1134107493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: KY 54434) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: WV 20109) |
| Enumeration Date | 2006-01-06 |
| Last Update Date | 2020-09-21 |