| NPI | 1801174651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: NV 19838) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MI 4301099327) |
| Enumeration Date | 2011-07-27 |
| Last Update Date | 2022-11-02 |