| NPI | 1215137179 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: SD 9276) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: CO 50130) |
| Enumeration Date | 2007-07-19 |
| Last Update Date | 2014-08-14 |