| NPI | 1730455775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: KY 52531) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NE 27615) |
| Enumeration Date | 2012-03-23 |
| Last Update Date | 2021-06-16 |