| NPI | 1215972377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: CA A102101) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MI 4301087947) |
| Enumeration Date | 2006-06-20 |
| Last Update Date | 2015-02-17 |