| NPI | 1619288602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: MN TP107788) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MO 2010020741) |
| 207V00000X Obstetrics & Gynecology (Licence: ND 13170) | |
| Enumeration Date | 2010-06-24 |
| Last Update Date | 2014-10-22 |