| NPI | 1902210925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: WI 74244) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MI 4301105231) |
| Enumeration Date | 2014-06-18 |
| Last Update Date | 2020-10-16 |