| NPI | 1780659920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: ID M-11086) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MO 2003025568) |
| 207V00000X Obstetrics & Gynecology (Licence: WA MD60171764) | |
| Enumeration Date | 2006-02-21 |
| Last Update Date | 2016-03-07 |