| NPI | 1245200807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: MT 12064) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MN 27828) |
| 207V00000X Obstetrics & Gynecology (Licence: SD 2636) | |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2023-03-07 |