| NPI | 1508820796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: SC 86988) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: CT 024427) |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2022-01-11 |