| NPI | 1093805392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: WV 20877) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: VA 0101232504) |
| 207V00000X Obstetrics & Gynecology (Licence: NC 9500564) | |
| 207V00000X Obstetrics & Gynecology (Licence: MI 4301057671) | |
| Enumeration Date | 2006-10-15 |
| Last Update Date | 2007-12-08 |