| NPI | 1194068601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207VX0201X Obstetrics & Gynecology, Gynecologic Oncology (Licence: GA 84635) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: WI 62430) |
| 207V00000X Obstetrics & Gynecology (Licence: MN 106671) | |
| Enumeration Date | 2013-04-03 |
| Last Update Date | 2020-09-29 |