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 |