| NPI | 1245210905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: WV 21124) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: VA 0101237239) |
| Enumeration Date | 2006-01-19 |
| Last Update Date | 2022-04-06 |