| NPI | 1588660625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: NC 200100527) |
| Additional Taxonomies | 174400000X Specialist (Licence: NC 200100527) |
| Enumeration Date | 2005-06-23 |
| Last Update Date | 2020-10-25 |