| NPI | 1164685632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: NY not yet) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: WA MD60122545) |
| 207V00000X Obstetrics & Gynecology (Licence: CA A112478) | |
| Enumeration Date | 2008-07-05 |
| Last Update Date | 2021-02-03 |