| NPI | 1396986279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: VA 0101040892) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NC 19308) |
| Enumeration Date | 2009-03-23 |
| Last Update Date | 2012-11-20 |