| NPI | 1609978808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: WI 53723) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 53723) |
| 207V00000X Obstetrics & Gynecology (Licence: AZ 005103) | |
| 207V00000X Obstetrics & Gynecology (Licence: MO 2005041214) | |
| Enumeration Date | 2006-09-01 |
| Last Update Date | 2021-02-04 |