| NPI | 1780667808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: WY 3578A) |
| Additional Taxonomies | 174400000X Specialist (Licence: WY 3578A) |
| Enumeration Date | 2005-11-22 |
| Last Update Date | 2023-03-07 |