| NPI | 1164490611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: MI 4301067907) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MN 65787) |
| Enumeration Date | 2006-03-10 |
| Last Update Date | 2024-09-12 |