| NPI | 1346210176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: NC 19540) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: VA 17481) |
| Enumeration Date | 2006-01-24 |
| Last Update Date | 2007-07-08 |