| NPI | 1609875897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: FL OS8676) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: VA 0102023539) |
| Enumeration Date | 2005-07-19 |
| Last Update Date | 2011-12-21 |