| NPI | 1194757393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: ID O-0646) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MI 5101016745) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2015-09-03 |