| NPI | 1922132414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: AZ 45042) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 102880) |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2019-04-25 |