| NPI | 1508849118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: MO 35506) |
| Additional Taxonomies | 171W00000X Contractor (Licence: MO 35506) |
| Enumeration Date | 2005-11-29 |
| Last Update Date | 2019-09-19 |