| NPI | 1891429635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: MN 74706) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MN 32616) |
| Enumeration Date | 2022-07-15 |
| Last Update Date | 2023-07-14 |