| NPI | 1659371128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: MS 15343) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: LA 021971) |
| Enumeration Date | 2005-07-27 |
| Last Update Date | 2010-10-19 |