| NPI | 1922362128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: VA 0101280118) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MI 4301101428) |
| 207V00000X Obstetrics & Gynecology (Licence: WV 27963) | |
| Enumeration Date | 2012-07-02 |
| Last Update Date | 2024-03-25 |