| NPI | 1861486524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: KS 0417394) |
| Additional Taxonomies | 208600000X Surgery (Licence: KS 04-17394) |
| 208D00000X General Practice (Licence: KS 0417394) | |
| Enumeration Date | 2005-09-08 |
| Last Update Date | 2015-09-16 |