| NPI | 1336346568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: MT 41014) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MT MED-PHYS-LIC-41014) |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2015-06-17 |