| NPI | 1306953831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: WI 37618) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NV 10164) |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2014-08-08 |