| NPI | 1356552848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: AZ 44840) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MI 4301083806) |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2013-12-02 |