| NPI | 1295732139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: IA 29940) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: SD 3874) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2022-10-18 |