| NPI | 1396735981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: NM 20020275) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: WA MD25778) |
| 207V00000X Obstetrics & Gynecology (Licence: VA 0101018540) | |
| Enumeration Date | 2005-10-25 |
| Last Update Date | 2007-09-24 |