| NPI | 1811955420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: FL ME94818) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: WA MD60242430) |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2019-09-24 |