| NPI | 1255795456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: MN 64363) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MN 27756) |
| Enumeration Date | 2016-04-13 |
| Last Update Date | 2018-12-03 |