| NPI | 1467747386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: KY 54439) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: KY R2724) |
| 207V00000X Obstetrics & Gynecology (Licence: KY TP097) | |
| Enumeration Date | 2011-06-20 |
| Last Update Date | 2021-04-30 |