| NPI | 1194720250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: KY 41260) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: UT 172326-1205) |
| 207V00000X Obstetrics & Gynecology (Licence: MS 13746) | |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2016-03-04 |