| NPI | 1861500654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: WY 9432A) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: OR MD25997) |
| 207V00000X Obstetrics & Gynecology (Licence: NC 98-00815) | |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2015-03-20 |