| NPI | 1902928153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: MN 54657) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: WV 22446) |
| 207V00000X Obstetrics & Gynecology (Licence: WI 50350) | |
| 207VG0400X Obstetrics & Gynecology, Gynecology (Licence: WV 22446) | |
| 207VX0000X Obstetrics & Gynecology, Obstetrics (Licence: WV 22446) | |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2022-08-01 |