| NPI | 1568458651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207VG0400X Obstetrics & Gynecology, Gynecology (Licence: MA 40761) |
| Additional Taxonomies | 207VX0000X Obstetrics & Gynecology, Obstetrics (Licence: MA 40761) |
| Enumeration Date | 2005-09-23 |
| Last Update Date | 2007-08-07 |