| NPI | 1295784478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: MN 53692) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: WI 33795) |
| 207V00000X Obstetrics & Gynecology (Licence: IA 39336) | |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2021-04-02 |