| NPI | 1780725630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: MN 107345) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NM MD2010-0171) |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2014-04-01 |