| NPI | 1932101169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: FL ME98647) |
| Additional Taxonomies | 174400000X Specialist (Licence: OH 35062245) |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2013-01-22 |