| NPI | 1205157732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: OR MD202026) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: WY 10230A) |
| Enumeration Date | 2010-06-18 |
| Last Update Date | 2020-11-10 |