| NPI | 1235455684 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207VX0201X Obstetrics & Gynecology, Gynecologic Oncology (Licence: MA 245047)  | 
| Additional Taxonomies | 207VX0201X Obstetrics & Gynecology, Gynecologic Oncology (Licence: NH 19334)  | 
| 207V00000X Obstetrics & Gynecology (Licence: MA 245047)  | |
| Enumeration Date | 2010-04-09 | 
| Last Update Date | 2019-05-22 |