| NPI | 1366753089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: ID M-13098) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MO 2010017738) |
| 207V00000X Obstetrics & Gynecology (Licence: WA MD60444120) | |
| Enumeration Date | 2010-06-28 |
| Last Update Date | 2016-06-28 |