| NPI | 1700175585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: FL 148834) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MN 108333) |
| Enumeration Date | 2011-04-01 |
| Last Update Date | 2021-05-06 |