| NPI | 1760410203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: UT 1841801205) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: WY TL7076) |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2022-02-23 |