| NPI | 1265453500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: VA 0101038504) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NC 200400903) |
| Enumeration Date | 2006-07-22 |
| Last Update Date | 2014-10-20 |