| NPI | 1083610042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207VG0400X Obstetrics & Gynecology, Gynecology (Licence: PR 17160) |
| Additional Taxonomies | 207VG0400X Obstetrics & Gynecology, Gynecology (Licence: AZ 18402) |
| Enumeration Date | 2005-06-23 |
| Last Update Date | 2011-09-28 |