| NPI | 1275084477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: MO 100074) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: KS 04-31961) |
| Enumeration Date | 2016-10-23 |
| Last Update Date | 2016-10-23 |