| NPI | 1548521719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: WI 74247) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NE 1065) |
| Enumeration Date | 2012-06-05 |
| Last Update Date | 2021-01-08 |