| NPI | 1407858954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: SD 3477) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: WA MD00036138) |
| 207V00000X Obstetrics & Gynecology (Licence: CA G48490) | |
| Enumeration Date | 2005-08-15 |
| Last Update Date | 2008-01-16 |