| NPI | 1174525539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: MO R5J73) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: KY 31341) |
| Enumeration Date | 2005-08-15 |
| Last Update Date | 2014-04-02 |