| NPI | 1699745992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: NC 2014-02175) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: TN 33885) |
| 207V00000X Obstetrics & Gynecology (Licence: FL ME100440) | |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2015-03-30 |