| NPI | 1790077253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207VX0201X Obstetrics & Gynecology, Gynecologic Oncology (Licence: WA FB5259216) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MI 4301098193) |
| Enumeration Date | 2011-05-03 |
| Last Update Date | 2018-11-09 |