| NPI | 1679756852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: UT 7257824-1204) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MI 5101016473) |
| Enumeration Date | 2007-12-11 |
| Last Update Date | 2023-11-27 |