| NPI | 1124061924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: NC 22208) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: VA 0101037694) |
| 207V00000X Obstetrics & Gynecology (Licence: WI 48288-020) | |
| 207V00000X Obstetrics & Gynecology (Licence: IL 036-103874) | |
| 207V00000X Obstetrics & Gynecology (Licence: MN 45318) | |
| 207V00000X Obstetrics & Gynecology (Licence: MI 4301085899) | |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2008-03-04 |