| NPI | 1790734200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: KY 39806) |
| Additional Taxonomies | 207VX0000X Obstetrics & Gynecology Obstetrics (Licence: GA 057870) |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2019-10-28 |