| NPI | 1821389172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: MN 64277) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MT MED-PHYS-LIC-41524) |
| 207V00000X Obstetrics & Gynecology (Licence: NV DO2203) | |
| Enumeration Date | 2011-04-20 |
| Last Update Date | 2022-10-05 |