| NPI | 1053316570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207VG0400X Obstetrics & Gynecology, Gynecology (Licence: LA 23827) |
| Additional Taxonomies | 174400000X Specialist (Licence: LA 23827) |
| Enumeration Date | 2005-06-21 |
| Last Update Date | 2011-05-16 |