| NPI | 1023012523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: KS 0519181) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MO R9794) |
| Enumeration Date | 2005-06-13 |
| Last Update Date | 2015-01-09 |