| NPI | 1275573453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: NC 200401155) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NC 200401155) |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2017-04-05 |