| NPI | 1114908142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: SC 08302) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NC 2016-00822) |
| Enumeration Date | 2005-11-08 |
| Last Update Date | 2017-05-05 |