| NPI | 1972500031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: VA 0101057217) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: WV 21079) |
| Enumeration Date | 2005-07-05 |
| Last Update Date | 2007-08-28 |