| NPI | 1639380587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: NV 13093) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MI 4301086576) |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2022-07-21 |