| NPI | 1629119771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: MN 51692) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MO 2005018831) |
| Enumeration Date | 2007-02-10 |
| Last Update Date | 2022-04-29 |