| NPI | 1700878279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207VG0400X Obstetrics & Gynecology, Gynecology (Licence: UT 8836143-1205) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: KY 37011) |
| 207VG0400X Obstetrics & Gynecology, Gynecology (Licence: KY 37011) | |
| Enumeration Date | 2005-08-19 |
| Last Update Date | 2020-06-19 |