| NPI | 1215923289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: KY 46339) |
| Additional Taxonomies | 174400000X Specialist (Licence: KY 46339) |
| Enumeration Date | 2005-09-23 |
| Last Update Date | 2012-11-29 |