| NPI | 1417214933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: AK 107902) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MI not available) |
| Enumeration Date | 2012-04-20 |
| Last Update Date | 2016-06-01 |