| NPI | 1386655140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: WI 73367) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MO 33401) |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2024-05-09 |