| NPI | 1336241652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: PR 5668) |
| Additional Taxonomies | 174400000X Specialist (Licence: MI 5668) |
| Enumeration Date | 2006-09-05 |
| Last Update Date | 2014-07-22 |