| NPI | 1376819854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207VX0201X Obstetrics & Gynecology, Gynecologic Oncology (Licence: LA 312162) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: LA 312162) |
| 207VX0201X Obstetrics & Gynecology, Gynecologic Oncology (Licence: MN 60355) | |
| Enumeration Date | 2012-03-28 |
| Last Update Date | 2019-07-31 |