| NPI | 1053604819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207VX0000X Obstetrics & Gynecology, Obstetrics (Licence: WA op60274656) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: OH 58.003060) |
| Enumeration Date | 2011-05-26 |
| Last Update Date | 2012-09-07 |