| NPI | 1184633612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: MS 23669) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: KS 04-20673) |
| 207V00000X Obstetrics & Gynecology (Licence: FL ME119323) | |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2015-06-30 |