| NPI | 1578834610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: NV 20135) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MI 4301098900) |
| Enumeration Date | 2012-01-20 |
| Last Update Date | 2021-08-16 |