| NPI | 1265506893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207VG0400X Obstetrics & Gynecology, Gynecology (Licence: CA G61628) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: CA G61628) |
| 208800000X Urology (Licence: CA G61628) | |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2019-08-15 |