| NPI | 1205917481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207VG0400X Obstetrics & Gynecology, Gynecology (Licence: FL OS 10193) |
| Additional Taxonomies | 207VG0400X Obstetrics & Gynecology, Gynecology (Licence: KS 0523677) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2013-05-17 |