| NPI | 1881701522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207VM0101X Obstetrics & Gynecology Maternal & Fetal Medicine (Licence: NE 16327) |
| Additional Taxonomies | 363LX0001X Nurse Practitioner Obstetrics & Gynecology (Licence: NE 16327) |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2013-12-17 |