| NPI | 1417025479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: KY 45732) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MO 2004015144) |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2023-03-07 |