| NPI | 1245525930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: AZ 51043) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: AZ R72843) |
| Enumeration Date | 2011-06-10 |
| Last Update Date | 2017-11-02 |