| NPI | 1568467132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: MA 59552) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: CT 027487) |
| Enumeration Date | 2005-06-20 |
| Last Update Date | 2010-12-03 |