| NPI | 1245294578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: WV 17896) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: TN 14657) |
| 207V00000X Obstetrics & Gynecology (Licence: KY 22260) | |
| Enumeration Date | 2006-04-13 |
| Last Update Date | 2012-12-11 |