| NPI | 1609142306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: MS 25483) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: LA 305004) |
| Enumeration Date | 2012-03-27 |
| Last Update Date | 2020-04-01 |