| NPI | 1164406815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: PR 7101) |
| Additional Taxonomies | 174400000X Specialist (Licence: PR 7101) |
| Enumeration Date | 2005-12-05 |
| Last Update Date | 2016-11-03 |