| NPI | 1629239603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: WA OP60262172) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NY 255855) |
| Enumeration Date | 2008-06-22 |
| Last Update Date | 2021-07-12 |