| NPI | 1134129976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: FL me0059922) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL ME0059922) |
| Enumeration Date | 2005-07-22 |
| Last Update Date | 2018-12-12 |