| NPI | 1245229863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: NC 200601374) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: VA 0101236237) |
| Enumeration Date | 2005-10-17 |
| Last Update Date | 2021-04-01 |