| NPI | 1215930888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: WI 29274) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: IA 27023) |
| Enumeration Date | 2005-05-27 |
| Last Update Date | 2013-07-23 |