| NPI | 1760593255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183700000X Pharmacy Technician (Licence: NE 6190) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NE 21670) |
| 207V00000X Obstetrics & Gynecology (Licence: IA 34300) | |
| 207VX0201X Obstetrics & Gynecology, Gynecologic Oncology (Licence: NE 21670) | |
| 207VX0201X Obstetrics & Gynecology, Gynecologic Oncology (Licence: IA 34300) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2015-02-04 |