| NPI | 1720048929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: NC 9500893) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: SC 16917) |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2021-08-18 |