| NPI | 1295722387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: MN 58300) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MO 2005019928) |
| Enumeration Date | 2005-10-04 |
| Last Update Date | 2015-03-09 |