| NPI | 1780683011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: AL 00010905) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: AL 10905) |
| Enumeration Date | 2005-07-19 |
| Last Update Date | 2020-08-21 |