| NPI | 1285766964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: MN 50622) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: CT 038445) |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2011-03-02 |