| NPI | 1396785986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: MN 24577) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: WI 20035-020) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2011-05-09 |