| NPI | 1235327404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: WV 17237) |
| Additional Taxonomies | 174400000X Specialist (Licence: WV 17237) |
| Enumeration Date | 2007-10-12 |
| Last Update Date | 2018-09-18 |