| NPI | 1124276357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207VG0400X Obstetrics & Gynecology, Gynecology (Licence: SC 8377) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 8377) |
| Enumeration Date | 2008-08-29 |
| Last Update Date | 2013-05-14 |