| NPI | 1255590998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: VA 0101264106) |
| Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant |
| 207V00000X Obstetrics & Gynecology (Licence: DC MD044224) | |
| Enumeration Date | 2008-06-06 |
| Last Update Date | 2018-05-02 |