| NPI | 1376527945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207VX0000X Obstetrics & Gynecology, Obstetrics (Licence: AZ 42743) |
| Additional Taxonomies | 207VG0400X Obstetrics & Gynecology, Gynecology (Licence: NY 094467) |
| Enumeration Date | 2005-12-06 |
| Last Update Date | 2011-09-15 |