| NPI | 1750329454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: VA 0101270527) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MN 48475) |
| Enumeration Date | 2006-06-03 |
| Last Update Date | 2021-09-10 |