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 |