| NPI | 1679552053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: CO 50974) |
| Additional Taxonomies | 207VG0400X Obstetrics & Gynecology Gynecology (Licence: IA 18988) |
| Enumeration Date | 2006-01-12 |
| Last Update Date | 2012-08-20 |